I am a Medical Provider and have received a Distribution Check from the Department. What is this check for?
Your claim was adjudicated by a third party administrator (PayerFusion). The administrator sent out remittance advices monthly as the claims were adjudicated. The check is a cumulative total of the individual claims submitted.
I am a Medical Provider and have received multiple Distribution Checks from the Department. What are these checks for?
If claims were submitted with multiple NPIs and/or multiple billing addresses, they may have been evaluated separately and you may receive more than one check. Additionally, your evaluated claims may have contained both Medicare and Medicaid components which may also result in multiple checks issued.
I am a Medical Provider. How can I determine what accounts/patients the check pertains to?
You should refer to remittance advices previously received from PayerFusion. If you still have questions regarding the check and matching it with the remittance advices of multiple claims, please contact PayerFusion directly at 305-400-4773 or toll-free 855-414-8242.
Can I get my distribution check(s) reissued?
No. Any funds related to uncashed distribution checks will ultimately be transferred to the Florida Division of Unclaimed Property.
Do I have health care coverage now?
No. FHCP members had continued health care coverage with the company until January 1, 2015. However, FHCP's health care contracts terminated upon that date and FHCP no longer provides health care coverage.
FHCP members who did not select a new plan prior to January 1, 2015, were automatically enrolled by CMS into Original Medicare with a Prescription Drug Plan. Benefits provided under Original Medicare, even with a Prescription Drug Plan, are different than those the FHCP members may have received as members of a Medicare Advantage Plan such as FHCP.
Please note that FHCP members who made a new plan choice during Medicare Open Enrollment for coverage beginning January 1, 2015, will still be enrolled in that plan beginning January 1, 2015.These members' coverage through Florida HealthCare Plus, Inc. continued through December 31, 2014.
FHCP members should contact their agents or 1-800-MEDICARE (1-800-633-4227) - available 24 hours a day, 7 days a week - for more information regarding these matters. The Receiver sent notices to the FHCP members notifying them of the receivership process.
Special Election Period
As a result of the receivership of FHCP, all beneficiaries enrolled in FHCP had a Special Election Period through February 28, 2015 to enroll in a plan of their choosing. All dual eligible or those eligible for the Low Income Subsidy could enroll in another plan at any time. A beneficiary that selected another Medicare Advantage or Medicare Advantage-Prescription Drug plan was covered under the new plan effective the first day of the next month after they enroll. Please contact 1-800-MEDICARE (1-800-633-4227) for more information regarding these matters.
Policy and Coverage Information
As of January 1, 2015, all FHCP members who did not enroll in another Medicare Advantage Plan by the end of December 31, 2014 automatically have continued health care coverage through Original Medicare Fee-for-Service (FFS) and a Prescription Drug Plan (PDP) as of January 1, 2015.
Members should contact their agents or 1-800-MEDICARE (1-800-633-4227) for more information regarding these matters.
FHCP members are urged to carefully read any letters they receive from the Receiver and/or CMS as they will include very important information about the member's health care coverage after January 1, 2015.
I am owed money for services provided before FHCP was ordered into receivership. What is the procedure for payment of these claims?
Non-Medical/General Creditor Claims:
The Receiver mailed Proof of Claim (POC) forms to all known general creditors of FHCP on 5/26/2015. If you have not received a POC, please use the Contact Us button to request a form. Please keep in mind that the FHCP claim filing deadline was December 31, 2015, and claims filed after that date are considered late filed.
I have received a Notice of Determination from the Department. What do I need to do next?
If you agree with the amount listed as “Amount Recommended Claimant”, you do not need to do anything further. If you are not in agreement with the amount listed, you need to follow the instructions on the front of the form where it explains that you must file your written objection with both the Division and The Clerk of Court.
I am a Medical Provider and have received a Notice of Determination from the Department. How can I determine what accounts/patients the “Amount Recommended Claimant” pertains to?
If your Notice of Determination reflects a code of 66 or 67, your claim was adjudicated by a third party administrator (PayerFusion). The administrator sent out remittance advices monthly as the claims were adjudicated. The "Amount Claimed" and the "Amount Recommended Claimant" are cumulative totals of the individual claims submitted. If claims were submitted with multiple NPIs, billing addresses, and involve both Medicare and Medicaid coverage they may have been evaluated separately and you may receive more than one notice.
Please review the information on your Notice of Determination and compare it to your claim submissions and corresponding remittance advices. If you have questions regarding the evaluation of your claim or matching of the remittance advices of multiple claims, please contact the Department using the "Contact Us" form on the Department's website or by calling (850) 413-3081 or toll free at 1-800-882-3054.
Is there a deadline for filing an objection regarding this Notice?
Yes. The deadline for filing an objection to the Second Interim Claims Report is July 12, 2018. The objection must be received by this date. Objections filed after the deadline will not be accepted. It is recommended the objection be sent by certified mail, return receipt requested.
The deadline for filing an objection to the First Interim Claims Report was April 3, 2017.
The Receiver entered into a contract with a third-party administrator, PayerFusion, to handle the processing of FHCP unpaid claims.
On November 10, 2015 and November 11, 2015, the Receiver sent notices with claim filing instructions to all known medical providers who may have claims unpaid by FHCP. These notices were sent by email to the email on file with the NPPES database or by regular mail if no email was available. If you have not received a notice, please contact PayerFusion by email, FHCP@payerfusion.com, or by phone at 888-424-7931. Always include the provider name, tax ID and the NPI in your inquiry.
I have provided services after the company was placed into receivership to a member of FHCP. Who is responsible for paying these bills?
The company, Florida Healthcare Plus, Inc. is responsible for paying services provided under the terms of its member agreements for claims occurring before January 1, 2015. Under Section 641.3154, Florida Statutes, HMO members/subscribers are not liable to any provider of health care services for any services covered by the HMO.
Can Medical Providers seek payment from former members/subscribers for debt owed by FHCP for medical services?
No. Under Section 641.3154, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO subscribers for such services. If you are contacted by a health care provider for such payment, you should inform the provider of this law.