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Updates and reminders
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Clinical Payment, Coding and Policy Reminders (1/27/2023)
Clinical Payment, Coding and Policy Reminders (PDF)
Clinical payment, coding and policy updates (Effective August 2022) (PDF)
Allergy immunotherapy injections policy (PDF)
Inpatient claim coding guidelines (PDF)
ICD-10 and Excludes 1 notes (PDF)
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Metabolic monitoring for children and adolescents on antipsychotics (PDF)
Using Ivermectin for COVID-19 (PDF)
Diabetic ketoacidosis associated with SGLT2 inhibitors (PDF)
Asthma and inhaled corticosteroids (PDF)
Liver enzymes, psychotropics and opioids (PDF)
Clinical inertia in patients with type 2 diabetes (PDF)
Chronic obstructive pulmonary disease (COPD) and inhaled corticosteroids (ICS) (PDF)
Fraud, waste and abuse: footbaths (PDF)
New boxed warning for Montelukast (Singulair): due to serious mental health side effects (PDF)
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Providers can’t charge Medicaid Managed Medical Assistance (MMA) and Florida Healthy Kids (FHK) members for personal protective equipment used during a covered service. Reimbursement from Medicaid is payment in full for all services. You can see the general Medicaid policy (PDF) for additional balanced billing prohibitions.
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2025
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August
Change in radiology prior authorization request (PDF)
SBIRT Training Provider Invitation (PDF)
Doula/Maternity Virtual Provider Training - Region I (08/20/2025) (PDF)
July
Screening, Brief Intervention, Referral to Treatment (SBIRT) Provider Training - 08.12.2025 (PDF)
Behavioral Analysis (BA) Provider Open Office Hours - Extended through 07/24/2025 (PDF)
No Prior Authorization Required - Effective 7/15/2025 (PDF)
June
ModivCare - Transportation Secondary Payer (PDF)
Doula/Maternity Virtual Provider Training -Region D (06.24.2025) (PDF)
May
Behavioral Health Billing Guidance -FHK (PDF)
Claim Submission Enhancement through Availity (PDF)
Behavior Analysis (BA) Provider Open Office Hours - Extended through 06/30/2025 (PDF)
Behavioral Health Provider Office Hours - Extended through May 15, 2025 (PDF)
April
Hospice Billing Education (PDF)
MMA Provider Satisfaction Survey 2025 (PDF)
LTC Provider Satisfaction Survey 2025 (PDF)
Behavior Analysis (BA) COC Process Reminder - COC ending 05/02/2025 (PDF)
Behavioral Health Provider Office Hours - Extended through May 15, 2025 (PDF)
March
March 2025 - Monthly Provider Training invite (PDF)
Behavioral Health Provider Office Hours - Extended through May 15, 2025 (PDF)
ProgenyHealth's Maternity Case Management Program Q1-2025 (PDF)
FHK HCPCS Codes for Depression Screening (PDF)
Behavior Analysis Claims Update (PDF)
February
Prior Authorization Requirements Update -Effective 04/01/2025 (PDF)
Behavioral Health Provider Open Office Hours - Extended through March (PDF)
Nurse Practitioner Credentialing Process (PDF)
Welcome Behavior Analysis (BA) Providers (PDF)
January
Behavior Analysis (BA) Provider Open Office Hours (PDF)
ABHFL - Virtual Provider Townhall LTC/HH/ALF - 02.06.2025 (PDF)
ABHFL - Virtual Provider Townhall BH- 02.05.2025 (PDF)
ABFHL - Virtual Provider Townhall MMA - 02.04.2025 (PDF)
Enhancing claims intake editing for SNIP Types 1-4 through a software change (PDF)
2024
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December
HCPCS Codes for Depression Screening (PDF)
October
October 2024 - Monthly Provider Training - General Training (10/24/2024) (PDF)
ProgenyHealth's Maternity Case Management Program (PDF)
Aetna and Quest Analytics Partnership (PDF)
Hurricane Milton Provider Communication (PDF)
Diabetic Supplies - Pharmacy Services changes effective 10/01/2024 (PDF)
September
Hurricane Helene provider communication (PDF)
ECHO Health Partnership for EFT/ERA Services (PDF)
July
July 2024 - Monthly Provider Training - General Training (07/24/2024) (PDF)
June
Hadlima added to Medicaid PDL (PDF)
June 2024 - Monthly Provider Training - LTC Training (06/28//2024) (PDF)
Members Eligibility Changes and Claims Submission - Updated Process (PDF)
Letter of Intent (LOI) vs Add Provider to Existing Participating Group (PDF)
Screen Time and Social Media Usage Questionnaire (PDF)
May
New Process Review for Diagnosis Related Group (DRG) Claims (PDF)
May 2024 - Monthly Provider Training - Behavioral Health (05/24/2024) (PDF)
April
ProgenyHealth's Maternity Case Management Program (PDF)
April 2024- Monthly Provider Training - Maternity (PDF)
April 2024 - Monthly Provider Training - General Training (PDF)
March
HCPCS Codes for Depression Screening (PDF)
March 2024 - Monthly Provider Webinar Training Invitation - Behavioral Health (3/27/2024) (PDF)
February
Billing Requirements (Taxonomy, NPI's) (PDF)
February 2024 - Monthly Provider Webinar Training Invitation - Maternity (2/29/2024) (PDF)
January
WanaBana Products Recall (PDF)
January 2024 - Monthly Provider Webinar Training Invitation - General Training (01/31/2024) (PDF)
Best Ways to Connect with Us (PDF)
ProgenyHealth's Maternity Case Management Program (PDF)
2023
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December 2023
Behavioral Health Monthly Provider Training Invitation (12/20/2023) (PDF)
November 2023
Monthly Provider Webinar Training Invitation - 11/30/2023 (PDF)
Care Champion Badges for Providers (PDF)
Upcoming Netsmart Trainings - Capturing Missed Visit Data (PDF)
October 2023
October 2023 - Monthly Provider Training - Maternity (PDF)
Upcoming changes to EVV requirements - Capturing missed visit data (PDF)
Monthly Provider Webinar Training Invitation - Maternity (10.26.2023) (PDF)
Provider Town Hall Invitation for MMA Providers in Region 6 - Tampa (PDF)
Provider Town Hall Invitation for LTC Providers in Region 6 - Tampa (PDF)
Provider Town Hall Invitation for MMA Providers in Region 7 - Orlando (PDF)
Provider Town Hall Invitation for LTC Providers in Region 7 - Orlando (PDF)
Provider Town Hall Invitation for MMA Providers in Region 11-Miami (PDF)
Skilled Nursing Facilities (SNF) Billing - Value Codes (PDF)
Provider Town Hall Invitation for LTC Providers in Region 11-Miami (PDF)
September 2023
SBIRT Provider Training Opportunity Notification Reminder (PDF)
Behavioral Health Monthly Provider Training Invitation (09/29/2023) (PDF)
Behavioral Health and Primary Care Provider Collaboration Survey (PDF)
Primary Care and Behavioral Health Provider Collaboration Survey (PDF)
SBIRT Webinar Training Provider Invitation (10.4.2023) (PDF)
Humatrope Added to FHK Preferred Drug List (PDF)
SBIRT Training Opportunity - 10/04/2023 (PDF)
HCPCS Codes for Depression Screening (PDF)
Hurricane Idalia Important Information (PDF)
August 2023
ProgenyHealth Maternity Care Management (PDF)
SBIRT Training Cancelled and Re-Scheduled (PDF)
Provider SBIRT Webinar Training Invitation - August 8, 2023 (PDF)
July 2023
SBIRT - Screening, Brief Intervention, Referral to Treatment Training Opportunity (PDF)
Monthly Provider Webinar Training - General Training (PDF)
COVID-19 Vaccine Non-Covered Procedure Codes Update (PDF)
June 2023
HCPCS Codes for Depression Screening (PDF)
Coordination of Care and Chronic Care Management (PDF)
Telemedicine Services Update - Effective July 1, 2023 (PDF)
American Rescue Plan Act - Provider Payment (PDF)
Monthly Provider Webinar Training - Behavioral Health (PDF)
SBIRT CME Providers Opportunity Reminder (PDF)
Behavioral Health and Primary Care Provider Collaboration Survey (PDF)
Primary Care Provider and Behavioral Health Collaboration Survey (PDF)
May 2023
HCPCS Codes for Depression Screening (PDF)
2023 Provider Satisfaction Surveys (PDF)
Monthly Provider Webinar Training - Maternity (PDF)
Office Hours and Telemedicine Services Survey (PDF)
Provider Taxonomy Requirements on Claims - Reminder (PDF)
ABHFL Provider OB/GYN Survey (PDF)
COVID-19 Public Health Emergency Flexibilities Ending (PDF)
Availity Provider Essentials Information (PDF)
April 2023
Monthly Provider Webinar Training - General Training (04/27/2023) (PDF)
2023 Provider Satisfaction Surveys (PDF)
Clinical Payment, Coding and Policy Updates - Anatomical Modifiers (Effective 4.10.2023) (PDF)
March 2023
Pharmacy and Prescribers Rejections (PDF)
Claim Edit for Genetic Testing related to Cystic Fibrosis (PDF)
Monthly Provider Webinar Training - Behavioral Health (03.30.2023) (PDF)
Provider Taxonomy Requirements on Claims (PDF)
February 2023
Monthly Provider Webinar Training (02/23/2023)
HCPCS Codes for Depression Screening (PDF)
January 2023
EFT/ERA Registration Services (EERS) (PDF)
Clinical Payment, Coding and Policy Reminders (1/27/2023) (PDF)
Maternity Provider Training Invitation (01.26.2023 & 01.31.2023)
Home Health (HH) - Home & Community Based Services (HCBS) Amendment Rates Increase (PDF)
2022
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December 2022
Provider Manuals, Newsletters and Notifications (PDF)
HCPCS Codes for Depression Screenings (PDF)
Clinical Payment, Coding and Policy Reminders (PDF)
Pharmacy and Prescribers Rejections (PDF)
Behavioral Health Provider Training Invitation (12/14/2022) (PDF)
Emcara Health Partnership (PDF)
Maternity Provider Training Invitation (12/7/2022) (PDF)
November 2022
Dx Gap Advisor Training (11/30/2022) (PDF)
CPT Coding Incentive Program Pilot (PDF)
Behavioral Health (BH) Training Invite (12/14/2022) (PDF)
Availity Webinars Invitation (PDF)
HCPCS Codes for Depression Screening (PDF)
Prior Authorization - Propat Website Access (PDF)
Provider Manuals, Newsletters and Notifications Information (PDF)
Hurricane Ian - Provisions of and Payment for Services Information (PDF)
October 2022
Donor Human Milk Coverage (PDF)
Obstetrical Provider Incentive (PDF)
Florida Healthy Kids Copay Waiver (PDF)
October Monthly Provider Billing and Claims Training (10/27/2022)
New peer-to-peer process (PDF)
September 2022
Hurricane Ian prior authorization update (PDF)
September monthly provider billing and claims training (PDF)
Cologuard new PA requirements (PDF)
Medicaid provider minimum wage supplemental wage agreement (PDF)
HCPCS codes for depression screening (PDF)
August 2022
Claims and encounters front-end edits (PDF)
New PA requirements effective 10/1/2022 (PDF)
August monthly provider billing and claims training (PDF)
Community health workers (CHW) education (PDF)
Claims correspondence and requests for appeal, complaints and grievances reminder (PDF)
Social determinants of health – Billable and payable Z codes (PDF)
July 2022
Coding update: Guidelines for modifiers 25, 59, XE, XP, XS, XU (PDF)
Important policy updates (Effective August 2022) (PDF)
July monthly provider billing and claims training (PDF)
Post-acute facility placement request process reminder (PDF)
June 2022
No provider notifications available this month
May 2022
May monthly provider billing and claims training (5/25/2022) (PDF)
Interim clinical considerations: Caring for newcomers from Ukraine (PDF)
Improved design of paper remit process (PDF)
Prior authorization requirements for spine codes (PDF)
Optimization of Medicaid precertification process (PDF)
April 2022
SBIRT Continuing Medical Education (CME) opportunity (PDF)
Therapy network of Florida (PDF)
April monthly provider billing and claims training (04/27/2022) (PDF)
Vaccines and vaccine administration billing guidance use (PDF)
March 2022
Payment policy for respiratory panels (PDF)
Service intensity add-ons (SIA) PA requirements (PDF)
Covid-19 visits and services (PDF)
March behavioral health webinar training (03/30/2022) (PDF)
General inpatient hospice process reminder (PDF)
Behavioral health authorizations (PDF)
February 2022
February grievance and appeals monthly provider billing and claims training (02/24/2022) (PDF)
February behavioral health webinar training (02/23/2022) (PDF)
ProgenyHealth neonatal care management — reminder (PDF)
Behavioral health integration update (PDF)
January 2022
HCBS provider funding due date reminder (PDF)
January Monthly Provider Billing and Claims Training (01/26/2022) (PDF)
ProgenyHealth neonatal care management (PDF)
Florida perinatal quality (FPQC) medical education trainings (PDF)
2021
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December 2021
Behavioral health provider update (PDF)
New physical health standard prior authorization (PA) request form (PDF)
Process validation update from SNIP level 2 to SNIP level 4 (PDF)
New vendor for paper claims and claims correspondence (effective 2/14/2022) (PDF)
December monthly provider billing and claims training (12/15/2021) (PDF)
Nursing facility enhanced rate October 2021 through December 2021 (PDF)
Claims appeal, complaint and grievance process reminder (PDF)
November 2021
November provider webinar billing and claims training (11/18/2021) (PDF)
COVID-19 monoclonal antibody infusions (PDF)
HCPCS codes for depression screening reminder (PDF)
SBIRT continuing medical education opportunity (PDF)
October 2021
October provider webinar billing and claims training 10/29/2021 (PDF)
CPT S9083-global fee urgent care centers (PDF)
Skilled nursing facility (SNF) prior authorization update (PDF)
September 2021
Obstetrics and gynecology — fetal prenatal genetic testing policy (PDF)
September provider webinar billing and claims training (PDF)
August 2021
COVID-19 liberalization policy revision 08/26/2021 (PDF)
August provider webinar billing and claims training 08/31/2021 (PDF)
Maternity health program — reducing C-section rates (PDF)
COVID-19 liberalization policy update (PDF)
July 2021
New HCPCS codes for depression screening reminder (PDF)
July provider webinar billing and claims training 07/29/2021 (PDF)
June 2021
Survey — Primary care & behavioral health member coordination of care (PDF)
Payment for prenatal obstetrical ultrasound (PDF)
June provider webinar billing and claims training 06/30/2021 (PDF)
COVID-19 temporary flexibilities ending July 1, 2021 (PDF)
Florida Healthy Kids copayment update effective 07/01/2021 (PDF)
Durable medical equipment (DME) and medical supply services (PDF)
Online pre-authorization submission update (PDF)
Maternal opioid recovery effort (MORE) (PDF)
EVV provider webinar training provider webinar billing and claims training (PDF)
Prior authorization requirements for J codes (PDF)
May 2021
Provider electronic fund transfer (EFT) and electronic remittance advice (ERA) information (PDF)
Florida Healthy Kids copayment extension through 06/30/21 (PDF)
Telemedicine requirements provider webinar billing and claims training (PDF)
Home health scope of service (PDF)
Electronic visit verification (EVV) provider webinar billing and claims trainings (PDF)
Clinical payment, coding and policy changes effective 05/25/2021 (PDF)
Electronic visit verification (EVV) requirements — effective 06/21/2021 (PDF)
HCPCS codes for depression screenings reminder (PDF)
Assisting Living Facilities (ALF) General Overview Provider Training (5/19/2021) (PDF)
April 2021
April 2021 — 2nd monthly provider webinar training (PDF)
Optum payment announcement (PDF)
Tobacco cessation billing update (PDF)
Bacterial urine culture billing guidance CPT 87086, 87088 (PDF)
Bill type error ending in 0 (PDF)
Florida Healthy Kids copayment extension through 05/31/21 (PDF)
Provider webinar billing and claims training (04/29/2021) (PDF)
COVID-19 PAR and NON-PAR providers vaccine administration billing guidance (PDF)
Aetna private duty nursing (PDN) services (PDF)
March 2021
Change HealthCare web connect tool enhancement (PDF)
Anesthesia billing modifiers (PDF)
Provider webinar billing and claims training — DME (03/31/2021) (PDF)
Global obstetric policy — multiple deliveries (PDF)
COVID-19 Florida Healthy Kids copayment extension through 04/30/21 (PDF)
February 2021
Assisting living facilities (ALF) general overview provider billing and claims training (PDF)
COVID-19 PCP-telemedicine survey (PDF)
DME/HME services rendered form reminder (PDF)
Global anesthesia and pain management (PDF)
COVID-19 FHK copayment extension (PDF)
Assisted living trainings — English (PDF) | Spanish (PDF)
Manifestation billing codes (PDF)
Provider webinar billing and claims training (2/24/2021) (PDF)
New screening tools and resources (PDF)
January 2021
LogistiCare name change announcement (PDF)
Interim billing for inpatient hospital services (PDF)
COVID-19 Florida Healthy Kids (FHK) extension through 02/28/21 (PDF)
Growth hormone criteria change for Florida Healthy Kids (FHK) (PDF)
Aetna provider portal transitioning to Availity — email request (PDF)
2020
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December 2020
Aetna provider portal transitioning to Availity (PDF)
Providers monthly webinar December training invitation (12/17/2020) (PDF)
November 2020
Electronic visit verification (EVV) requirements (PDF)
835s and remittance advise discrepancy notice (PDF)
Providers monthly webinar November training invitation (11/19/2020) (PDF)
October 2020
Providers monthly webinar October training invitation (10/29/2020) (PDF)
Provider enrollment revalidation process restart (PDF)
Florida Healthy Kids copayment extension (PDF)
DME/HME services rendered form (PDF)
New screening tools and resources (PDF)
September 2020
Patient responsibility billing guidelines (PDF)
Negative balance — collection remittance new process (PDF)
Long-acting reversible contraceptive (LARC) hospital reimbursement (PDF)
COVID-19 copayment and authorization extensions (PDF)
Adult community support services (PDF)
Tellus EVV and Aetna virtual town hall (PDF)
August 2020
New policies update effective date of service 07/28/2020 (PDF)
Providers special trainings (PDF)
New HCPCS codes for depression screening (PDF)
Upcoming claims review information (PDF)
COVID-19 copayment and authorization extensions (PDF)
Providers monthly webinar August training invitation 08/27/2020 (PDF)
Obstetric (OB) prior authorization requirements (PDF)
July 2020
Prior authorization process for custodial care and skilled nursing facility (PDF)
Florida Healthy Kids and Medikids immunizations update (PDF)
Polymerase chain reaction testing policy (PDF)
Home and community-based provider retainer payment limitations (PDF)
Providers monthly webinar July training invitation (07/30/2020) (PDF)
New website pharmacy updates (PDF)
COVID-19 waiver of prior authorization requirements for hospital transfers (PDF)
COVID-19 prior authorization reinstatement process for home health & DME services (PDF)
COVID-19 prior authorization reinstatement effective 06/19/2020 (PDF)
June 2020
Personal protective equipment policy reminder (PDF)
Providers monthly June webinar training invitation (06/25/2020) (PDF)
Provider relief funding information (PDF)
Inpatient diagnosis related group (DRG) adjustments (PDF)
May 2020
Prior authorization (PA) changes for 2020 (PDF)
COVID-19 extended benefits information (PDF)
Providers webinar training invitation (05/28/2020) (PDF)
COVID-19 members Medicaid eligibility benefits (PDF)
TL modifier clarification for early intervention therapy services (EIS) (PDF)
COVID-19 pandemic impact questionnaire (PDF)
April 2020
Obstetric (OB) ultrasounds codes and limits requirements (PDF)
COVID-19 electronic visit verification (EVV) requirements (PDF)
Florida Healthy Kids COVID-19 copayment waiver (PDF)
Providers webinar invitation — FHK and MMA billing and claims training (PDF)
March 2020
Removal of authorization requirement for observation level of care (PDF)
NEW early intervention services (EIS) prior authorization and modifier requirement (PDF)
COVID-19 telemedicine guidance (PDF)
COVID-19 prior authorization requirements (PDF)
COVID-19 home health agency (HHA) provider survey (PDF)
Providers webinar invitation — billing and claims training (PDF)
Member rights and responsibilities (PDF)
New review process for sterilization codes (PDF)
February 2020
Allergy testing policy reminder (PDF)
Grievance and appeals address change effective 03/01/2020 (PDF)
Orthotics and prosthetics prior authorization requirements (PDF)
Billing hospital-based urgent care services (PDF)
Changes to prior authorization for diabetic supplies (PDF)
Home health services coding and billing guidelines (PDF)
January 2020
Medicaid inpatient/observation notifications and authorizations (PDF)
HCPCS Code J3145 prior authorization changes (PDF)
Neuropsychological/psychological testing prior authorization changes (PDF)
Prior authorization for custodial and skilled SNF provider (PDF)
Expanded benefits suppliers (PDF)
EVV update provider notification (PDF)
Behavioral/mental health vendor clarification (PDF)
Value-added benefits for Florida Healthy Kids (FHK) members (PDF)
Florida Healthy Kids (FHK) primary care physician (PCP) assignments information (PDF)
2019
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December 2019
Florida Healthy Kids provider webinar (PDF)
Florida Healthy Kids continuity of care provider notification (PDF)
Electronic visit verification (EVV) implementation update (PDF)
Pediatric oncology clinical review process (Eviti)
November 2019
Florida Healthy Kids town hall (region 4) (PDF)
Housing assistance pilot program (region 7) (PDF)
October 2019
Behavioral health provider trainings (PDF)
New prior authorization form (PDF)
Pharmacy network changes (PDF)
September 2019
Integrated care management (PDF)
Florida Healthy Kids contract announcement (PDF)
August 2019
Electronic visit verification (EVV) solution implementation (PDF)
Remit advice and provider web portal education (PDF)
July 2019
HEDIS coding well and sick visits (PDF)
June 2019
Prior authorizations — custodial and SNF education (PDF)
Aetna Better Health of Florida payer ID information (PDF)
May 2019
Abuse, neglect, and exploitation provider training (ANE) (PDF)
April 2019
Unlisted and non-specific codes education provider communication (PDF)
Evaluation and management (EM) information (PDF)
March 2019
Authorizations fax number information (PDF)
February 2019
January 2019
Enhanced ambulatory patient groupings (EAPG) (PDF)
NPI Medicaid ID billing requirements (C85) (PDF)
Provider satisfaction survey (PDF)
2018
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December 2018
Continuity of care (COC) information (PDF)
Participating vendors list (PDF)
November 2018
Early Intervention Services therapy approval process (PDF)
October 2018
Home health and personal care services billing (PDF)
MediKids vaccine information — Children’s Health Insurance Program (CHIP) (PDF)
Non-emergency medical transportation changes (PDF)
September 2018
Anesthesia billing modifiers (PDF)
Integrated care management programs (PDF)
July 2018
Recoupment project information (PDF)
Urine drug testing (UDT) (PDF)
No prior authorization required on select X-rays and ultrasounds (PDF)
May 2018
MCNA preventive dental benefits outreach (PDF)
Aetna assistance program — Marjory Stoneman Douglas HS (PDF)
Enhanced ambulatory patient groupings (EAPG) physician notification (PDF)
Event notification service (ENS) participation (PDF)
January capitation payment delay (PDF)
Oncology pre-certification process (PDF)
Preferred home health agency (PDF)
Revised — national drug code (NDC) (PDF)
January 2018
New updates bulletin v.2 (PDF)
Clinical payment, coding and policy changes (PDF)
Prior authorization requirements (PDF)
MCNA pregnant woman outreach fax blast (PDF)
MCNA preventive dental benefits outreach (PDF)
Medicaid and FHK prior authorization requirements (PDF)