Florida Government Programs
This page highlights specific documents and forms which apply to Government Programs in Florida.
Medicare Information and Updates
Important Notice: Clinical Criteria and Prescribing of Atypical Antipsychotics for Preschoolers
Subject: Atypical antipsychotics use in preschoolers
Background: There has been a dramatic increase in utilization of atypical antipsychotics drugs in both children and adolescents since they were approved for use in 1989. Currently, there are very few well-controlled clinical studies to evaluate the use of atypical antipsychotics in very young children.
Atypical Antipsychotics clinical criteria update: Clinical criteria has been implemented to ensure the atypical antipsychotics are used safely and continued only if they have clearly documented efficacy on target symptoms for children under the age of 5 years. This clinical criteria reflects the Florida Medicaid Clinical Guidelines for the use of psychotherapeutic medications in children under age six, which may be accessed on the web at: http://flmedicaidbh.fmhi.usf.edu/, From the home page, select "Child Guidelines" under "Recommended Guidelines" from the main menu on the left of the page.
Rules: A preferred atypical antipsychotic will be approved for children under the age of 5 years based on one of the following criteria:
- Confirmed diagnosis of one of the following categories:
- Schizophrenia Spectrum Disorder
- Autism Spectrum Disorder (for Risperidone)
- Bipolar Disorder
-OR- - The child displays symptoms of, or aggression as a symptom of, one of the following:
- Developmental delay
- Autism
- Tourette's Syndrome
- Oppositional Defiant Disorder
- Conduct Disorder
-AND- - The child is unresponsive to other treatment modalities (unless contraindicated).
Procedure: Prior authorization requests can be called into our Prior Notification Center toll-free at 1-800-310-6826 or you can use the Prior Notification Request Form and fax it to 866-940-7328.
Audit tool: Reminder: Network clinicians and facilities are required to maintain high quality medical, financial and administrative records related to behavioral health services provided. These records must be maintained in a manner consistent with the standards of the community, and conform to all applicable laws and regulations. Optum may request copies of your records or may review them during an On-site Audit that includes a Treatment Record Review for a number of reasons, including but not limited to routine audit process or as part of a quality of care investigation. To ensure that you are in compliance with and meeting Optum Treatment Record content standards, please review the standards which are available at www.providerexpress.com . Select "Clinical Resources", then "Optum Network Manual" and "Treatment Record Documentation" to review.
The following audit tool information outlines Optum's expectation regarding clinical records documentation. Please take a moment to review these audit tools to ensure that your records documentation is in compliance with Optum standards.
Clinician Audit Tool
Facility Audit Tool
Appeals and Provider Dispute
Complaint Investigation and Resolution
Receive Payment and EOBs Faster Through Electronic Payments and Statements
Did you know that United Behavioral Health offers Electronic Payments and Statements (EPS) for our network Practitioners? This service is offered through Optum Financial Services. EPS allows you to receive your claim payments and remittance advices electronically instead of through the mail. Your claim payments will be deposited directly into your designated bank account, and you can access all your payment and remittance advice information online. To learn more about EPS and how it works, you can view a demonstration at www.optumhealthfinancial.com. With your enrollment, you not only receive United Behavioral Health/Optum claims and payments electronically, but also those from other payer organizations using OptumHealth's Electronic Payments and Statements (EPS) as well. Payers already using EPS include UnitedHealthcare, Medica, Harvard Pilgrim Health Plan and Evercare/SecureHorizons. You will be informed of additional payers as they are added to the network, through direct communications and the OptumHealth Financial Services Web site. If you have any questions about EPS that are not addressed by the "EPS Provider Demo" or Frequently Asked Questions (posted as Provider FAQs), contact EPS support by calling 1-800-557-5745 option 3, then option 4 or by sending an e-mail to the EPS team at EPS@optumhealthfinancial.com.
Save Time and Money: File Your Claims Electronically
Filing your claims electronically can help you save time and money. Less paperwork and administrative time means more time with your patients. United Behavioral Health currently accepts behavioral health and EAP claims electronically. Outpatient behavioral health claims can be submitted electronically through the Claim Entry feature of Provider Express or as an EDI transaction, and inpatient behavioral health claims can be submitted through an EDI transaction. Visit the EDI Claims page on Provider Express.
UnitedHealthCare of Florida Preferred Drug List
This Preferred Drug List (PDL) is a compilation of medications in various therapeutic classes for use in administering the prescription drug benefits of members in AmeriChoice and UnitedHealthcare government-funded health plans. These include Medicaid, State Children's Health Insurance Programs (SCHIP) and various programs for the uninsured for which the prescription drug benefit is covered in whole or in part by AmeriChoice and UnitedHealthcare.
Informed Consent Requirement for Psychotherapeutic Medication
Contract Overview and Training Materials
Cultural Competency: UnitedHealthcare updates its cultural competency plan annually. The Cultural Competency plan outlines overarching goals to improve services along with objectives set to meet those goals. It also provides an overview of components of the plan: diversity of both health plan employees and the clinical network, provider education, linguistic services, community outreach, data analysis, electronic media, the performance improvement program and an annual evaluation. The plan ensures that the cultural and linguistic needs of plan members are met. As a network clinician, you are critical to the success of this plan. It is through your skills and expertise that members receive the cultural and linguistic support that they need to make sound treatment decisions and lead healthier lives. The complete United Healthcare cultural competency plan is available on line. Follow the links below for the Cultural Competency Plan for UnitedHealthcare. Should you require a printed copy of the plan, please contact your Network Manager.
- Plan:
UHC FL Cultural Competency Plan
- Resources:
The National Center for Cultural Competence
Cultural Competency Resources for Health Care Providers
National Standards on Cultural & Linguistically Appropriate Services (CLAS)
The Provider's Guide to Quality and Culture
Office of Minority Health - Targeted and Intensive Case Management Documentation Requirements:
--COMING SOON - Information regarding Managed Options for Medicaid Recipients:
Medicaid offers assistance for members who wish to learn more about the managed care options available to them and/or the benefits available in their counties. - Information can be found at:
http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/options.shtml - or via phone at:
Choice Counseling Helpline: 1-866-454-3959 (Baker, Broward, Clay, Duval and Nassau Counties)
Medicaid Options Helpline: 1-888-367-6554 (All Non-Reform Counties) - Key Health Plan Contractual Requirements Grid:
--COMING SOON
This page highlights specific documents and forms which apply to Government Programs in this state. Please refer back to the main Provider Express home page for all other clinical, administrative, network and technical resources.