Certification as a Health Care Provider

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According to s. 440.13(1) (d), Florida Statutes (F.S.), a "certified health care provider" is a provider approved to receive reimbursement through the FL WC System. A certified provider may be a physician, a licensed practitioner or a facility approved by the Division or a provider who has entered an agreement with a licensed managed care organization to provide treatment to injured employees.

A health care provider (HCP) interested in rendering medical treatment and care to an injured employee must be certified pursuant to Rule 69L-29.002, F.A.C. by the Division. Certification of a HCP includes documentation that the HCP has read and is familiar with the portions of the statute, impairment guides, standards of care, protocols of treatment, and rules that govern the provision of remedial treatment, care, and attendance.

The following HCPs licensed through AHCA are deemed certified and are not required to complete the HCP Tutorial to be eligible to receive reimbursement for services rendered to injured employees:

• Nursing Homes licensed through AHCA under chapter 400;
• Home Health Agency licensed through AHCA under Chapter 400;
• Home Health Medical Supplier/Durable Medical Equipment Provider licensed through AHCA under Chapter 400; or
• Any physician, recognized practitioner or facility under contract with a managed care organization licensed through AHCA.

The Certification Process

The HCP Certification process includes the completion of The Health Care Provider (HCP) Tutorial, the electronic tool by which a provider becomes familiar with the statutory requirements and administrative rules to meet the minimum criteria for certification and to ensure successful participation in the FL WC System. A provider must correctly answer 95% of the tutorial review questions to become a certified provider.

Upon completion of the HCP Tutorial, an applicant will be able to demonstrate a familiarity with policy related to the delivery of medical treatment and services under the FL WC System specific to:

•  The certification requirements for participating in the FL WC System.
•  The roles and responsibilities of the employer, carrier and provider in promoting the self-executing features of the FL WC System to timely provide the injured employee medically necessary treatment.
• The importance of rendering treatment in compliance with the standards of care to ensure all evaluation and treatment is appropriate to the injured employee’s documented physiological and clinical problem.
• The importance of communicating the injured employee’s medical status through proper billing and reporting of services to facilitate the timely provision of benefits to which the injured employee is entitled.

Successful completion of the HCP Tutorial is a pre-requisite for participating as a certified health care provider to be eligible to receive reimbursement under the FL WC System.

A provider remains certified unless the provider elects to have his/her name removed from the Division's Provider Database or the Division enters an adverse action against the provider for violation(s) of Chapter 440, F.S.

Updating the Division’s Provider Databases

Health care providers shall notify the Department in writing of any change in the status of that health care provider's license, or mailing address within 10 days of such change. Such changes shall be sent to: Division of Workers' Compensation, Office of Medical Services, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232.

 

Frequently Asked Questions