Summary of policy
Per the Agency for Health Care Administration (AHCA), Outpatient Hospital Services Coverage Policy, Florida Medicaid reimburses one emergency department visit per day per recipient.
To align with this AHCA policy, Staywell will implement a new Claims & Payment Policy: Same Day Emergency Department Visits.
What does this mean for providers?
Effective Sept. 1, 2019 (Sept. 15 for Lee Health), our claims team will enforce the new Claims and Payment Policy (Policy Number: 109) for Same Day Emergency Department Visits. For members age 21 and older, Staywell may deny secondary emergency department claims for the same member (recipient) on the same day unless Staywell has directed the member to seek emergency services.
We are here to help. To learn more, please call Provider Services at 1-866-334-7927 (TTY 711).
Why is this policy necessary?
- It ensures Staywell enforces the existing AHCA Policy 59G-4.160, 4.2.1
- It ensures members receive the appropriate frequency of services in accordance with AHCA policy
