Florida & Georgia Medicaid Service Providers

Florida & Georgia Medicaid require the Service Provider’s ID to be included on claims for selected services. This document will show the user how to set up a Service Provider ID and how that ID is used when generating claims.

Add a Service Provider ID

1. Open a Staff Record.
2. Click the Special Identifier button on the General tab.
   
    
3. Click Add button on the Special Identifiers page.
   • If the Staff Member has a registered NPI number, skip to step 4.
   • If the Organization is still using Social Security Numbers as Service Provider IDs, skip to step 5.
      
4. Staff Member has a registered NPI number enter or check the following fields:
   • Select Type [NPI].
   • Enter the ID in ID / Number / Code.
   • Check Service Provider.
   • Click OK.

     Note: If the Staff Member also has a Special Identifier Type of [NPI] and Rendering Provider is selected, the Staff will be treated as a Rendering Provider for the Service Provider and Service Provider rules will be ignored.

     
     
      
5. If the Organization is still using Social Security Numbers as Service Provider IDs:
   • Select Type - [SSN].
   • Enter the SSN in ID / Number / Code, and do not check any Identifiers.

     NOTE: Alternatively, the user can enter the staff’s SSN on the General tab of the Staff Record.

     
     

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Florida & Georgia Medicaid Service Provider Claim Requirements

• If the service is direct intervention and the Staff Member for the appointment does not have a Rendering Provider NPI number, the Provider, in this case, is called the Service Provider.
• A separate Claim must be created for each Service Provider/Place of Service.
• If the Service Provider’s ID is an NPI, the NPI is displayed in the white section of 24J with no Qualifier.  The Provider’s name is displayed in Box 31.
  
   
• If the Service Provider’s ID number is an SSN, the SSN and the Qualifier G2 are displayed in the pink section above the charge line in Box’s 24I and 24J.
  

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Funding Source Setup
 

In order for Claims Wizard to apply the above rules - your Funding Source Names must include one of the following:

• FL Medicaid
• GA Medicaid

In a future release, a standalone option will be available on the Funding Source record to indicate that Service Provider and/or Session Time requirements should be used without the need for a specific Funding Source name.

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Generating Claims in the Claims Wizard
 

The Claims Wizard will display Service Provider IDs for Funding Sources that have been properly named using the instructions from the prior section.

The Service Provider ID is displayed in Steps 1, 2, and 3 of the Claims Wizard to the right of the Rendering Provider. Information that is required for every claim is grouped together so it is visible without having to scroll to the right in the screen (Place of Service, Rendering Provider, etc.).

More Info on Generating Claims: How to Use the Claims Wizard

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