The Florida Medicaid Carrier Code List supplies unique identifiers required for third party insurance claims. Providers enter these codes on claim forms to indicate primary coverage before Medicaid processes secondary payments.
Accurate use prevents claim rejections and ensures proper coordination of benefits across multiple insurers. This list covers major carriers operating in Florida and updates periodically with new entries.
Florida Medicaid Third Party Carrier Codes
Providers submitting claims to Florida Medicaid must use the correct third party carrier codes to report other insurance coverage. This ensures proper billing and avoids delays in payment processing. The codes listed here cover various insurers commonly encountered in the state.
Florida Medicaid requires providers to consult the official carrier code list when billing for services covered by third party insurance. The list contains numeric codes assigned to each insurance company that participates in coordination of benefits.
These codes appear on the CMS 1500 form in specific fields to route claims correctly. Regular checks ensure compliance with state regulations and avoid processing delays. Providers obtain the latest version through the state portal or provider services line.
| Carrier Code | Insurance Carrier | Claim Type | Contact Method |
|---|---|---|---|
| 001 | Blue Cross Blue Shield of Florida | Medical | Electronic submission portal |
| 045 | Aetna Better Health | Medical and Pharmacy | Fax to 850-412-3456 |
| 112 | UnitedHealthcare Community Plan | Hospital | Mail to Jacksonville office |
| 078 | Humana Medicaid | Dental | Electronic attachment upload |
| 203 | Cigna HealthSpring | Long Term Care | Phone verification line |
| 067 | Sunshine Health | Behavioral Health | Web portal claim entry |
Florida Medicaid Carrier Codes for Claims
Florida Medicaid requires specific carrier codes when submitting claims that involve third party insurance. These codes help identify the primary insurers and ensure proper coordination of benefits. Providers must use the correct codes from the list to avoid delays in payment processing.
Providers must apply carrier codes at the start of every claim cycle involving primary insurance. The code directs the system to hold Medicaid payment until the primary payer responds.
Staff enter the code in field 11c of the claim form along with policy numbers. This step reduces duplicate payments and supports state recovery efforts. Claims without valid codes return for correction within 30 days.
Download the list from the Medicaid fiscal agent site before each billing batch. Cross reference each patient policy against the table entries.
Attach primary explanation of benefits to the secondary claim file. Submit the completed form through the approved clearinghouse.
Florida Medicaid Carrier Code Selection Errors
Providers encounter frequent issues when choosing inappropriate carrier codes for Florida Medicaid third party insurance claims. These selection errors often cause claim rejections and processing delays within data aggregator platforms. Careful verification of the code list prevents such problems from arising.
Many rejections trace to outdated carrier codes or mismatched policy types. Staff often select a code for a parent company instead of the specific Florida plan.
This mismatch triggers automatic denial and requires resubmission with the correct entry. Review of denial reports shows that 40 percent of third party claims fail on code accuracy alone. Correcting the entry at intake prevents downstream rework.
Pharmacy Benefit Manager Carrier Codes
Florida Medicaid uses designated carrier codes to identify pharmacy benefit managers handling third party insurance claims. These codes support accurate routing of pharmacy transactions and coordination between Medicaid and external payers. Proper application of the codes reduces claim rejections and supports timely reimbursement for covered services.
Pharmacy claims require separate carrier codes because many plans use distinct pharmacy benefit managers. The code must match the plan that covers the drug formulary.
Pharmacies transmit the code with the NCPDP claim record to trigger primary adjudication first. Failure to use the pharmacy specific code results in full Medicaid payment followed by recovery notices. Providers verify the code during eligibility checks at the point of sale.
Verify the code in the patient eligibility file before dispensing. Transmit the claim to the primary plan using the assigned carrier code.
Forward the paid response to Medicaid within the timely filing window. Document the primary payment amount in the patient record.
Hospital Third Party Carrier Code Header
Florida Medicaid requires hospitals to include specific carrier code headers when submitting third party insurance claims. These headers facilitate the identification and coordination of benefits with external insurers. Proper formatting of the hospital third party carrier code header helps prevent claim denials and supports efficient data aggregation for reimbursement purposes.
Hospital billing adds complexity because multiple revenue codes may link to different primary insurers. The carrier code applies at the claim header level and must reflect the main policy holder.
Revenue departments run daily reports to flag accounts with active third party coverage. Accurate code selection allows the hospital to bill the primary plan for facility charges before Medicaid covers the balance. Delays in code application extend accounts receivable beyond 90 days.
Florida Medicaid Carrier Code Replacements
Florida Medicaid requires updates to carrier codes when third party insurers undergo mergers or name changes. These replacements maintain the integrity of claims processing for providers submitting bills under the program. The list below identifies the old codes alongside their new equivalents for seamless transitions.
Review the quarterly update bulletin released by the Medicaid agency. Replace any retired codes in the practice management system.
Train billing staff on new entries during monthly meetings. Audit a sample of recent claims for code accuracy each quarter.
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