Providers Must Bill Fully Liable Medicare Advantage Plans for All Services

Effective immediately, the Florida Medicaid Management Information System (FMMIS) will no longer pay for services billed to Medicaid for recipients enrolled in a Fully Liable Medicare Advantage Plan.

Fully Liable Medicare Advantage Plan.

The Fully Liable Medicare Advantage Plans are responsible for and cover the costs for the provision of Medicaid covered services found in the Fully Liable Medicare Advantage Plan Medicaid Covered Services, which are incurred by enrolled dual eligibles who meet the eligibility criteria for full Medicaid benefits. Please review the list to verify if you provide a service covered by the Fully Liable Medicare Advantage Plan. 

Providers must check a recipient’s eligibility via the Florida Health Plan Portal to verify their Medicare and Medicaid eligibility.  To identify if you provide services to a Fully Liable Medicare Advantage Plan enrollee via the Florida Health Plan Portal, in the “TPL” section, the recipient’s TPL coverage will show “Fully Liable Medicare Advantage Plan” as well as the Plan’s (Carrier) name.

Source: https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2021_05/D-SNP_Billing_July1_050321.pdf