Walk-ins are welcome

Fingerprinting for Medicaid Providers Re-Enrollment Application

The Medicaid Provider Re-enrollment Application Packet consists of:


• A Florida Medicaid Provider Reenrollment Application
• A Medicaid Provider Agreement
Fingerprint Cards (or proof of exemption from fingerprinting)
In addition, applicants should attach any supporting documentation necessary to show proof of valid licensure, ownership of a tax id, a name change, change in ownership, or any other documentation supporting continued eligibility for enrollment in Florida Medicaid.


Criminal History Screening – Florida Medicaid requires criminal history screening for both enrolling and re-enrolling Medicaid providers. The following individuals are required to be listed in question 3 and to submit to a criminal history check:


• All partners or shareholders with an ownership interest of five percent or more
• All officers (this includes the president, vice president, etc.)
• All directors (this is the board of directors)
• Financial records custodian
• Medical records custodian
• All billing agents who are employees of the provider
• All managing employees or affiliated persons, including pharmacy managers
• All individuals authorized to sign on the account used for electronic funds transfer


If an individual belongs to more than one of the above categories, they only require one criminal history check.


Each applicant seeking to participate in the Medicaid program must submit a complete set of fingerprints for each person declared on an initial or renewal application for the purpose of conducting a criminal history record check.
In an effort to streamline the background screening process, AHCA is now encouraging providers to use vendors like IDENTICO who offers electronic fingerprint scanning services. This process avoids the traditional fingerprint card process where finger prints are “rolled” in ink onto an FBI fingerprint card and mailed hard copy with a check for processing. This improves accuracy with fewer rejections (no ink smudges) and improves timeliness of the background investigation process.


This enhancement to the provider enrollment process allows providers to enroll without mailing any hard copy documentation. Rather, with electronic scanning of fingerprints handled by approved vendors, applicants may submit their application and all remaining supporting documents through the online Enrollment Wizard.


The following provides detailed information on how to take advantage of this new option:


Level of Screening Required

Provider applicants to Florida Medicaid require a Level 2 screening which involves a fingerprint check of state and federal criminal history information conducted through the Florida Department of Law Enforcement (FDLE) and the Federal Bureau of Investigation (FBI).


Submission of Fingerprints

All provider applicants are encouraged to submit their fingerprints electronically.

Forms of Electronic Screening


The most common form of electronic screening involves use of a LiveScan device which is a type of equipment used to directly capture fingerprints through a scanning function. Persons being screened place their hands directly on the scanner for reading. Fingerprint scanning using a LiveScan device provides faster results and generally costs less than hard card scanning as there is less handling involved. LiveScan capture also produces a better quality print, so has a lower rejection rate of illegible prints (no ink smudging, etc).


IDENTICO LLC- the LiveScan vendor approved to submit fingerprint requests through the Florida Department of Law Enforcement (FDLE). The cost of services is $54.25 and it includes state and federal criminal history search fees imposed by FDLE and FBI. The LiveScan screening is available at our office locations at 3948 Pembroke Road, Suite E, Pembroke Park, FL, 33021 or through mobile services where the vendor will either come to the provider location (based on certain volumes and fees) or another pre-arranged location.


To ensure the results of your screening are delivered to Florida Medicaid and not to AHCA’s Division of Health Quality Assurance, be sure to use the correct account number, or ORI, assigned to Florida Medicaid. The ORI which should be used for Medicaid Enrollment and Re-Enrollment is FL922013Z.


Hard card scanning is a method of submitting a traditional fingerprint card where fingerprints are “rolled” in ink onto an FBI fingerprint card. Cards may be converted to “electronic” by using a machine that scans the cards. There is typically a fee associated with “rolling the prints” as a high degree of skill is required to achieve the necessary quality. Hard cards for Florida Medicaid screening must be supplied by Florida Medicaid because they must include the preprinted ORI# to assure results are returned to Florida Medicaid. The completed cards must be mailed along with a check or money order for $43.25 per card to the Medicaid fiscal agent for processing at: P.O. Box 7070, Tallahassee, FL 32314-7070. Be sure to include your application tracking number or Medicaid ID so the cards may be applied to the correct records. To request a supply of fingerprint cards, contact the fiscal agent at 1-800-289-779, Option 4.


Exemptions to Submission of Fingerprints:

• Individuals who successfully submitted a fingerprint card to Florida Medicaid within the previous twelve months. Attach a list of all persons requesting this exemption including full name and social security number.
• Individuals who successfully completed both a state and national criminal history check (level 1 and level 2) within the previous twelve months through another state agency or department. Attach proof on letterhead from the state department or agency that required the background screening showing all of the following: the individual’s name, social security number, type of screening, date screening was completed, and the results.
• Not-for-Profit Board of Directors – Certain directors of not-for-profit organizations are exempt from background screening for Medicaid under Subsection 409.907 (8)(a), F.S.. Submit a completed Organization Affidavit for Exemption from Medicaid Criminal History Check including a list of the names and social security numbers for any directors requesting this exemption.


Accuracy of statements contained in any exemption request will be subject to verification by Medicaid.


Rejected Fingerprint Cards – Fingerprint cards that are rejected by the FBI will be returned directly to Medicaid Contract Management. Rejected fingerprint cards will be accompanied by a United States Department of Justice Form 1-17 A, Rev 5-2-96, or Form 1-12, Rev 4-28-97, that lists the various reasons a fingerprint card may be rejected. If a fingerprint card is rejected, it will be necessary for the applicant to obtain and submit a new fingerprint card. In order to preclude duplicate payments and to receive a complete FBI record, the applicant must submit the rejected fingerprint card along with the new fingerprint card. Failure to submit a new fingerprint card will result in denial of a pending reenrollment or termination of an active provider.


NOTE: Providers who have had a fingerprint card rejected by the FBI are encouraged to request the law enforcement office supply a letter declaring the prints to be the best obtainable prints when they are re-fingerprinted. If the second card also rejects, the best prints letter will facilitate a manual search of the FBI records in lieu of submitting a third fingerprint card.


IDENTICO LLC has fingerprinted hundreds of physicians from various health care groups as part of their Medicaid Provider Re-enrollment Application. Most fingerprinting had been made on our mobile units.  We came to clinics, hospitals, mental health facilities etc. and fingerprinted doctors and provider’s administration.


IDENTICO is FDLE authorized Live Scan vendor serving South Florida.  With any question related to Level 2 background checks please call us at (954) 239-8590 or visit us online at www.myidentico.com for more information. We provide Mobile Fingerprinting Services and would come to your facility to fingerprint any size groups. Visit our office located at 3948 Pembroke Road, Suite E, Pembroke Park, FL, 33021 for all fingerprinting, background screening or drug testing needs.

Sign up for our Newsletter

Click edit button to change this text. Lorem ipsum dolor sit amet, consectetur adipiscing elit