Due to Hurricane Milton, the Florida Agency for Health Care Administration has directed health plans to implement a provisional provider Medicaid enrollment process for providers.

Florida Medicaid has waived some initial requirements for providers to submit normally required information and documentation when applying for provisional enrollment. 

Who is the provisional provider enrollment process for?

It is for providers within the state of Florida, as well as in other states, who are not enrolled with Florida Medicaid but have provided services to displaced Florida residents in the aftermath of Hurricane Milton. This is a temporary enrollment process that is intended to ensure reimbursement for all services provided in good faith to eligible Florida Medicaid recipients who reside in the impacted Florida counties.

Counties impacted: Alachua, Baker, Bradford, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Gilchrist, Glades, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lafayette, Lake, Lee, Levy, Madison, Manatee, Marion, Martin, Miami-Dade, Momoe, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Suwanee, Taylor, Union, and Volusia.

Participating providers

Follow the steps below.

1. For each provider who is not enrolled in Medicaid, but has rendered services to eligible Florida Medicaid recipients, complete a: 
2. Statewide Medicaid Managed Care (SMMC) Provisional Out-of-Network Provider Enrollment form.
   1. SMMC Florida Medicaid Provisional Attestation Form – Medicaid Services Provided. Complete the form for the first eligible Medicaid recipient to whom services were provided.
3. Submit the forms to your aligned provider representative, if you have one. Otherwise, please email the forms to either CentralFloridaProviders@Cigna.com or SFLMedicareProviders@Cigna.com

Nonparticipating providers

Follow the steps below once the claim has been denied. 

1. For each non-Medicaid provider who has rendered services to eligible Florida Medicaid recipients, complete a: 
2. SMMC Provisional Out-of-Network Provider Enrollment form 
3. SMMC Florida Medicaid Provisional Attestation Form – Medicaid Services Provided. Complete the form for the first eligible Medicaid recipient to whom services were provided.
4. Mail the forms to Cigna Healthcare, PO Box 188081 Chattanooga, TN 37422, or fax them to 855.350.8671.