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Florida application medicaid enrollment 2026

The document is a Managed Care Treating Provider Application for Florida Medicaid, intended for providers rendering services to Medicaid recipients through contracted managed care entities. It outlines the necessary information required for enrollment, including provider details, certifications, and approval from a managed care plan. The application emphasizes the importance of accuracy and completeness in the information provided, as false claims may lead to legal consequences.

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Click ‘Get Form’ to open the Florida Medicaid Provider Enrollment Application in the editor.
Begin by entering your Provider Name and DBA (if applicable). Ensure that the Physical Street Address is complete, avoiding P.O. Boxes.
Fill in your City, State, County Name, and Zip Code. Include your Telephone Number and optional Business E-mail address for contact purposes.
Input your Tax ID Number (either SSN or FEIN) and Professional License if applicable. Complete the Provider Type Code and National Provider ID (NPI) fields.
If relevant, provide your Facility License Number, Practice Type Code, Category of Service, CLIA License Number, Ownership Code, and Specialty Code as required.
Review the Applicant Certification section carefully. Legibly print your name as the applicant or authorized signer, include your title, signature, and date.
Ensure that a representative from the Managed Care Plan has signed off on the application before submission. Make a copy for your records.

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What is required to get Medicaid in Florida?

You might not qualify for senior Medicaid if your income or assets exceed the programs limits, or if you dont meet other requirements such as citizenship status or level of medical need.

How does a Florida resident apply for Medicaid?

Applications for Florida Medicaid Waiver services (financial eligibility) are processed by the DCF. You may go to the DCF Public Benefits Services website site or call DCF at 1- (866) 762-2237 for more information about Medicaid. All documents must be provided to DCF for financial eligibility determination.