Notification of New Out-of-State Provider Application Form

Effective September 1, 2017, the Agency for Health Care Administration (Agency) replaced the Florida Medicaid Out-of-State Provider Enrollment Application (March 2008) with the Out-of-State Provider Application Form (August 2017). Florida Medicaid reimburses out-of-state providers who provide services to an eligible Florida Medicaid recipient in accordance with the Florida Medicaid Provider General Handbook.  Florida Medicaid policies are located at https://ahca.myflorida.com/medicaid/review/index.shtml.