Reprocessing Fee-For-Service Independent Laboratory Claims for Calendar Years 2018 and 2019 Provider Type(s): 50 and 70

As a result of a US Department of Health and Human Services Audit, it was determined that the Agency for Health Care Administration (Agency) made payments to providers for Medicaid services that were not paid in accordance with established fee schedules

The Independent Laboratory Fee Schedules posted on the Agency’s Web site in 2018 and 2019 contained the correct rates, however the rates were not updated in the Florida Medicaid Management Information System (FMMIS).

All Provider Reimbursement Schedules and Billing Codes can be found on the Agency’s web site at Historical Medicaid Reimbursement Schedules.

The Agency has identified the impacted Fee-for-Service claims. Paid claims, with dates of service between January 1, 2018 and October 16, 2019, containing at least one procedure code from the Provider Fee Schedule (Independent Laboratory Fee), and paid to a Provider Type (50) – Independent Lab, will be systematically reprocessed.

No action is required from the Medicaid providers. The reprocessed claims will be reported on the provider’s remittance advice dated July 7, 2021.

Source: https://ahca.myflorida.com/medicaid/review/Historical_Reim.shtml