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E 77027 Medicaid Florida 270 276 837 835

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© Availity, LLC, all rights reserved. | Confidential and
proprietary.
| Updated 05/22/2019
AVAILITY ENROLLMENT FORM
PAYER ID: 77027
PAYER NAME: MEDICAID FLORIDA
Required: Submission of this form indicates the completion of the enrollment instructions.
Enter Provider Information (print or type)
Provider Organization Name
Provider Tax ID
Provider/Group NPI
Availity Customer ID (Required)
Provider Legacy ID (if available)
Provider Billing Address
City
State
Zip
Authorized Name
Phone
Email Address
Choose which transaction you are enrolling (Claims, Remits, Eligibility or All):
Enrollment Instructions
Please see the below enrollment instructions for Florida Medicaid Web Portal.
Availity Trading Partner ID: 89185
Enrollment Questions: Please Contact Florida Medicaid EDI Helpdesk at 866-586-0961
© Availity, LLC, all rights reserved. | Confidential and
proprietary. | Updated 05/22/2019
Florida Medicaid Connectivity through Availity
Availity is pleased to offer our users free connectivity to Florida Medicaid for the submission of Claim
(837), Eligibility and Benefit Inquiry (270/271), and Claim Status Inquiry (276/277) transactions as well as
the receipt of Electronic Remittance Advice (835) via the Availity® Health Information Network!
To accommodate this offering, Availity is undergoing a connection change with Florida Medicaid. In order
to ensure proper registration for connectivity to Florida Medicaid, please be sure to complete the steps
outlined in the following pages. Once completed, Availity will be authorized to receive any 271s, 277s, or
835s (ERAs) that may be generated by the payer. If these actions are not taken, Availity will not be able to
receive these files from the payer and deliver them to you.
Background
As Florida Medicaid transitioned their fiscal agent services from ACS to EDS on June 23rd, 2008 a
registration process was implemented for Florida Medicaid providers to gain access to their Florida
Medicaid Web Portal accounts. A Web Portal registration information letter was mailed to each active
Florida Medicaid provider with a Personal Identification Number (PIN) noted to assist providers with
activating their Web Portal Accounts. If you have activated your Florida Medicaid Web Portal account, you
may proceed with the following steps for adding Availity as an Agent, beginning on November 15, 2008.
Note: If you have not activated your Florida Medicaid Web Portal account and no longer have the
personal access information (PIN letter) to register, please contact Florida Medicaid to retrieve this
information by calling 800.289.7799 and selecting Option 5 to speak to Provider Services.
Step 1: Register to Receive Electronic Remittance Advice
(ERA/835) Files via Availity (Optional)
If you wish to receive ERA (835) files from Florida Medicaid via the Availity Health Information Network,
you must first submit a completed Florida Medicaid Electronic Remittance Advice (ERA) Authorization and
Electronic Data Interchange Agreement. Once you have received email notification of your successful
registration for the receipt of FL Medicaid ERA files via Availity, you may proceed with step 2.
Note: If you do not wish to receive FL Medicaid ERA files via Availity, skip Step 1 and proceed to Step 2.
© Availity, LLC, all rights reserved. | Confidential and
proprietary. | Updated 05/22/2019
Step 2: Access the Florida Medicaid Web Portal
Beginning on November 15, 2008, visit the Florida Medicaid Web Portal at https://home.flmmis.com and enter
your established username and password. Once logged in, you will need to select Account Management.
Step 3: Add Availity as an Agent
Once you have landed on the Account Management Home Page, you will need to click Add Agent at the top of
the screen. This will bring you to the Add Agent screen. When prompted please enter the e-mail address linked
to Availity which is:
shannon.pope@availity.com. Once the e-mail address has been entered, click Search and Availity,
L.L.C. will be listed as an Agent.
Note: The above e-mail address is not monitored and should not be used for communications or support
contact.
Step 4: Assigning Agent Roles
Upon searching the designated Florida Medicaid Availity e-mail address, shannon.pope@availity.com, proceed
by clicking Select.
Step 5: Agreeing with the Terms of Service
Read through the Terms of Service and then click Yes, I agree to advance.
Step 6: Modify Agent to allow for Trade File Upload and Download
of the 271, 277, and 835/837 Transactions
This step allows you to modify the roles for an agent.
› Please select the hyperlink
for Florida Web Portal listed on the left hand side under Step 1: Select
the system you
want to modify access
› On the right hand side of the screen under Step 2:
Modify the permissions for Florida Web Portal
select
Claims,
Download 997, Download TA1, Reports, Trade Files
,
Download 271
, Download
277, and Download 835. Once these steps are complete, click Save Changes
.
Note: Upon completion of these steps, all future 271, 277, and 837/835 transactions will
be delivered to Availity.
© Availity, LLC, all rights reserved. | Confidential and
proprietary. | Updated 05/22/2019
Step 7: Accessing Existing ERA (835) Files
If there were 835 files created for you prior to your completion of the steps above, they will be delivered to
your personal Florida Medicaid Web Portal account. To access those outstanding 835s, you will need to
do the following:
1. Access the Florida Medicaid Web Portal at
h
ttps://home.flmmis.com and enter
y
o
ur
es
tab
l
i
shed
username and password. Once logged in, you will need to select Florida Web Portal.
2. On the next screen that appears, click Trade Files.
3. Click download and select the Document Type of 835_X12_BA
TCH. You will see a search button
listed on the right hand side of the screen to initiate your request. Any 835 that has been generated
since the transition of Florida Medicaid fiscal agent services from ACS to EDS will be listed for you to
download.
Note: Upon completion of these steps, all future 271, 277, and 837/835 transactions will
be delivered to Availity.
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E 77027 Medicaid Florida 270 276 837 835

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Completed 1 October 2019

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