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Claims
All claims – SFCCN PSN, CMSN-Broward (Medicaid), CMSN-SE FL Region (Florida KidCare) and CMSN-S FL Region (Florida KidCare) – should be submitted promptly after the service is provided. Providers shall have one year from the date of service to submit clean claims in accordance with the Florida Medicaid Program. Further detail on clean claims submittal can be accessed in the Medicaid Provider Reimbursement handbooks, CMS-1500 or UB-04. All Medicaid handbooks can be found on the EDS website, http://mymedicaid-florida.com.
Providers can submit claims via electronic or paper submission. For further details on electronic submission, please contact the appropriate plan/Subnetwork. Paper claims must be submitted on a red and white CMS-1500 or UB-04. Paper claims should be sent to the plan/Subnetwork of the enrollee at one of the addresses listed below with the appropriate plan indicated in the address.
Public Health Trust of Miami-Dade County:
South Florida Community Care Network (PHT) or Children's Medical Services Network – South Florida Region (PHT)
Attn: Claims Department
155 S Miami Ave, Suite 110
Miami, FL 33130
Memorial Healthcare System:
South Florida Community Care Network (MHS) or Children's Medical Services Network – Broward (MHS) or Children's Medical Services Network – Southeast Florida Region (MHS)
Claims Department
P.O. Box 849029
Pembroke Pines, FL 33084
North Broward Hospital District:
South Florida Community Care Network (NBHD) or Children's Medical Services Network – Broward (NBHD) or Children's Medical Services Network – Southeast Florida Region (NBHD)
Claims Department
P.O. Box 21128
Fort Lauderdale, FL 33335-1128
Claims payment shall be payment in full, minus any applicable Medicaid co-payments for SFCCN PSN enrollees. CMSN-Broward, CMSN-Southeast Florida Region and CMSN-South Florida Region enrollees have no co-payments.
Inquiries regarding claims payment should be directed to the address above or through a phone call to the appropriate plan/Subnetwork. If a denial of payment letter is received, please direct appeals with the appropriate supporting documentation to the appropriate plan/Subnetwork address listed above, Attention: Claims Review.
Third Party Liability – It is the provider's responsibility to notify the enrollee's plan/Subnetwork if an enrollee has coverage in addition to SFCCN or CMSN. SFCCN or CMSN will then forward this information to the Florida Medicaid Program or the Florida KidCare Program, whichever is appropriate based on the enrollee's plan/Subnetwork, for research.