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New law eliminates access to FL Medicaid claims portal

New changes to the Agency for Health Care Administration (AHCA) in Florida could impact your practice’s claims submission and remit processes. CS/HB 1057, signed into law in June, eliminates parts of the AHCA’s requirements for Medicaid reporting. As part of those changes, Florida providers will no longer have access to CMSfree Medicaid reporting portal.1

The changes included in the bill come with some good news and some challenges, as some providers will need to adjust in order to make reports and submit claims through clearinghouses, rather than directly through the Medicaid portal. Let’s take a look at what’s changing and how you can prepare for the measure, which took effect July 1.1

What’s in the new law?

The good news is that it eliminates some reporting requirements that have been in effect for several years. Providers will no longer need to report on:


  • Medicaid Managed Care Transition
  • Pharmaceutical Expense Assistance Program
  • Medicaid Drug Spending Control Program

The first of these requirements, Medicaid Managed Care Transition Report, was implemented in the transition from traditional Medicaid programs to the new Medicaid Managed Care program. Since this transition has been complete for the last seven years, this report is now redundant and can be ended.1

The Pharmaceutical Expense Assistance Program Report only applies to Medicaid recipients who have been eligible since 2006 or earlier. There are now only 14 patients still eligible for this assistance in Florida, and while they will continue to enjoy eligibility, reporting on this program is no longer necessary.

Finally, the Medicaid Drug Spending Control Program is another legacy reporting requirement that was implemented in the transition from Medicaid Fee-for-Service (FFS) to the new model. Because much of the eligible population for this program has dual eligibility with Medicare and may also be receiving medications through skilled nursing facilities, the data collected from this report may not be an accurate reflection of medication spending trends for the Medicaid population.

What does the law mean for your healthcare organization?

While Florida providers are now no longer responsible for these reporting requirements, the bill also eliminates access to the free portal for Medicaid claims submissions. Instead, providers must send those claims through a clearinghouse connecting them indirectly to federal payers.

Fortunately, Inovalon works with organizations in Florida and across the country to simplify claims submission and remit processes bringing all submissions together through a single, centralized portal for all payers.

To learn more about how Inovalon can help you automate claims submissions, decrease denials and streamline remits, request a demo today.

  1. “New bill revises AHCA Medicaid practices, Nicole Pasia, State of Reform, June 22, 2021.

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By Inovalon