Fiscal Agent Operations

Medicaid Fiscal Agent Operations

The Bureau of Fiscal Agent Operations has oversight responsibilities for the Fiscal Agent provider enrollment, claims processing and payment, management of the the Florida Medicaid Management Information System (FMMIS) and the Decision Support System (DSS).

Provider Enrollment

The bureau section provides coordination of Fiscal Agent provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the Medicaid managed care plans, the Medicaid Regional Offices, and program operating partners at the Department of Health and the Agency for Persons with Disabilities.

Recipient File Management

The bureau section maintains integrity of recipient eligibility data in the FMMIS and provides oversight of Medicaid Fiscal Agent recipient file management functions.

Special Projects/Project Management

This bureau section ensures compliance of the Florida Medicaid Management Information System (FMMIS) with federal and state regulations; develop federal Advance Planning Documents (APD) to receive approval for Medicaid system projects and enhanced federal funding, and develop state Legislative Budget Requests (LBR) for fiscal agent projects.

Decision Support Systems

This bureau section monitors the Decision Support System (DSS) portion of the Fiscal Agent contract to ensure system availability, access and accuracy for authorized State users. The DSS staff also assists users with building ad hoc queries, customized reports and large data extracts.

Compliance Reporting and Claims/Encounter Support

This bureau section is responsible for contract compliance reporting of all phases of the Medicaid Fiscal Agent’s operations.

Systems Maintenance

This bureau section is responsible for arranging, coordinating and reviewing System Maintenance Customer Service Requests (CSR); file maintenance, audits, claims reprocessing, issue identification and production issues resolution.

Systems Projects

This bureau section is responsible for coordinating, developing, processing and approving CSRs submitted to the Fiscal Agent. Staff is also responsible for planning, coordinating, and overseeing special projects.