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Hurricane Ian - Florida Medicaid Provisional Enrollment for Out-of-State Providers

For out-of-state providers, who are not enrolled with Florida Medicaid and who provided services to displaced Florida residents, Florida Medicaid has created a provisional provider enrollment process. Florida Medicaid has waived the requirements for providers to submit documentation showing the nature of the treatment, as well as other normally-required information, when applying for provisional enrollment.

For fee-for-service provisional enrollment, Florida Medicaid requires the following: 

  • A fully completed claim form containing the provider’s active National Provider Identifier (NPI), along with the provider’s SSN/FEIN; 
  • A signed Florida Medicaid Provider Agreement (MPA); 
  • A copy of the provider’s professional license; and 
  • An optional signed Florida Medicaid Electronic Funds Transfer (EFT) Authorization Agreement, if providers choose to receive payment electronically.

Managed care plans performing provisional enrollment can accept the same or similar items used by the plans when enrolling out-of-network providers.

Additional details and instructions are located on the Florida Agency for Health Care Administration webpage.