Published Date: Dec 05, 2022
Effective January 1st, 2023, Health Network One’s Therapy Network of Florida will be the mandatory network for Outpatient physical therapy, speech therapy and occupational therapy services provided in a free-standing Facility or office setting, for Simply Medicare enrollees in the expansion Counties below.
Medicare Coverage
Brevard, Charlotte, Citrus, Clay, Collier, Duval, Flagler, Indian River, Lake, Lee, Manatee, Marion, Putnam, St. Johns, Sarasota, Sumter and Volusia
Continuation of Care (COC)
Continuation of Care (COC) period is up to 30 days from the date that the enrollee switched to Simply Healthcare Plans, Inc. (Simply). The COC period ends when the previous Health Plan’s auth expires or when the 30 days ends; whichever comes first. You are not required to obtain an authorization from HN1/TNFL to continue providing these services during the Continuation of Care Period.
If you are NOT a participating provider with HN1/TNFL, please refer the enrollee to their Primary Care Physician or ordering Provider so that they may refer the enrollee to a participating therapist. Enrollees may also contact Simply Healthcare Plans, Inc. (Simply) to locate a participating therapist. Simply Member Services: 1-844-406- 2396(TTY 711) Simply Provider Services: 1-844-405-4296.
Continuation of Care Claims
Continuation of Care (COC) period is up to 30 days from the date that the enrollee switched to Simply Healthcare Plans, Inc. (Simply). The COC period ends when the previous Health Plan’s auth expires or when the 30 days ends; whichever comes first. You are not required to obtain an authorization from TNFL to continue providing these services during the Continuation of Care Period. Along with your COC submittal of claims, providers will be required to submit written documentation such as prior existing orders, prior authorizations and treatment plan/ plan of care, in order to receive payment on their claim.
Authorizations
Authorizations for date-of-service on or after January 1, 2023, can be requested via our Provider Web Portal at https://mytnfl.com/hs1portal. Fax is available as an emergency backup via TNFL fax at 1-855-410-0121.
Claims
For services rendered on or after January 1, 2023, the preferred method of claim submission is EDI. Providers may use the TNFL Provider Web Portal by going to https:// mytnfl.com/hs1portal to submit claims. Providers may also use the portal to check status of your submitted claims 24/7 regardless of the method of submission (paper, electronic, Web Portal entry). If you wish to sign up, please visit www.mytnfl.com to register for an account.
If your office prefers to submit claims electronically via clearinghouse, our Payer ID is 65062 for professional claims and 12k89 for institutional claims.
If your office prefers to submit via paper, please send CMS 1500 forms or other approved billing forms (i.e. UB04) to:
Therapy Network of Florida Claims Processing Center
P.O. Box 350590
Fort Lauderdale, FL 33335-0590
Questions?
For more information, please visit our website at www. mytnfl.com and download the TNFL Simply Healthcare Provider Manual.
If you have any questions regarding this communication, please contact TNFL’s Provider Relations Department at 1-888-550-8800, Option 2.