• Overview
• Authorization for Service
  • Referral Department
  • Case Management Department
  • Request a HMO Pre-Authorization
  • Request POS or Triple Option Pre-Certification
  • Refer a Member for Complex Case Management
• Claims
  • Medicare Part D Vaccines
  • Submit Paper Claim
  • Electronic Data Interchange(EDI)
• Coding
• Contracting with Florida Health Care Plans
• Credentialing
• Provider Handbook
• Provider Relations
• Referral Guidance
  • Laboratory Orders for all Networks

Referral Department

The FHCP Referral Department is responsible for the receipt and processing of authorization requests from Patients and Providers for covered services that require pre-authorization of FHCP payment.

• Answering Intake calls and inquires regarding authorization requests, available participating providers, etc.
• Managing pre-certification for Triple Option and Point of Service
• Providing coordination and continuum of care in collaboration with other departments/divisions
• Scheduling approved authorization requests
• Educating Providers, their staff and patients regarding the FHCP referral and authorization process
• Managing negative determination notifications