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Providers

Important information about Hurricane Dorian

Effective August 28, 2019, Governor Ron DeSantis declared a state of emergency in all 67 Florida counties due to the potential impact of Hurricane Dorian.

PRIOR AUTHORIZATIONS: To support providers and members, normal prior authorization requirements were temporarily lifted from August 28, 2019 through September 8, 2019. This applied to participating and non-participating providers.

For claims submission guidelines: http://www.prestigehealthchoice.com/provider/claims-and-billing/index.aspx.

PRESTIGE CLAIMS PAYMENT EXCEPTION PROCESS:  Prestige will reimburse for all medically necessary services that were provided to an impacted Prestige member DURING the Florida state of emergency Executive Order 19-190 issued on 8/28/19 through 9/8/19 for the following:

  • The service(s) would have required a prior authorization
  • The service(s) was rendered by a non-participating provider
  • The service(s) exceeded normal policy limits for the service(s)

During this grace period, providers should follow the usual Prestige claims submission process.

For medically necessary services that were provided to an impacted Prestige member OUTSIDE of the grace period to be considered for reimbursement by Prestige, the provider MUST submit the following information:

  • A completed Prestige Claims Exception Form
  • A paper CMS-1500 or UB-04 claim
  • A copy of the Agency’s letter reflecting your Medicaid provisional enrollment number*

*In order to receive payment for covered services, the servicing and billing provider must be enrolled with the Florida Agency for Health Care Administration (AHCA). To enroll in Florida Medicaid, providers must complete the Agency’s provisional (temporary) enrollment process. The process for provisional provider enrollment is located at http://www.mymedicaid-florida.com.   

Please provide all documentation in hard copy. All information should be sent to:

Prestige Health Choice
Claims Exception Process-Hurricane Dorian
11631 Kew Gardens Avenue, Suite 200
Palm Beach Gardens, FL  33410

For any questions regarding the claims payment exception process for Hurricane Dorian, please call Prestige Provider Services 1-800-617-5727 or email your question to HurricaneClaimExceptionProcess@prestigehealthchoice.com.

For more information on health care facility updates and resources, please visit: https://ahca.myflorida.com/MCHQ/Emergency_Activities/DORIAN_2019.shtml.

If you need additional assistance, please call Prestige Provider Services at 1-800-617-5727.


Prestige Health Choice recognizes that our provider partnerships are a major factor in our ability to deliver quality Medicaid services and neighborhood-based care throughout Florida. Every day, Prestige's mission to provide quality, affordable service to the underserved in our communities is reflected in the care, expertise, and support that our providers offer.

Coverage in Medicaid regions 2 and 3

Please be advised that effective February 1, 2019, Prestige Health Choice will no longer provide Statewide Medicaid Managed Care (SMMC) program coverage for Medicaid enrollees in Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington, Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union counties.

Our last date of coverage for Medicaid enrollees will be January 31, 2019. Please continue to provide services to Prestige Health Choice members until this date. Please continue to work with us to process any remaining claims for services provided prior to February 1, 2019.

Continuity of care provisions

Effective December 1, 2018, Prestige Health Choice began to receive enrollees transitioning into the 2018 – 2023 Statewide Medicaid Managed Care program serving Region 9 (Miami-Dade and Monroe counties) and Region 11 (Martin, Palm Beach, St. Lucie, Indian River, and Okeechobee counties). To ensure continuity of care (COC) during the transition period for all health plan members, we have instituted the following COC provisions:

  • Providers should not cancel appointments with current patients. We will honor any ongoing treatment that was authorized prior to the recipient’s enrollment for up to 60 days after December 1, 2018.
  • Providers will be paid. Providers should continue offering any services that were previously authorized, regardless of whether the provider is participating in our network. We will pay for previously authorized services for up to 60 days after December 1, 2018. We will pay providers at the rate previously received for up to 30 days.
  • Providers will be paid promptly. During the continuity of care period, we will follow all timely claims payment contractual requirements.
  • Prescriptions will be honored. We will allow recipients to continue to receive their prescriptions through their current providers for up to 60 days after December 1, 2018, until their prescriptions can be transferred to a Prestige Health Choice network provider.

Direct secure messaging

Direct secure messaging (DSM) enables managed care organizations and providers to securely send patient health information electronically to many types of organizations. Prestige Health Choice encourages network providers to use the Florida Health Information Exchange (HIE) Opens a new window to send orders, records, results, and other health information.

We want to thank our providers for helping to make Prestige Health Choice a better health care plan. Your feedback, questions, and concerns are always welcome. Call Provider Services at 1-800-617-5727 to speak to a representative.