Enrollee Transfer Request

For enrollee use only. Providers are prohibited from submitting member transfer requests.
Please note, all transfer requests will be effective the day of transfer submission. Please allow up to 48 hours for transfers to be completed.

Step 1: Search for Provider Office

Select Benefit Plan

Benefit Plan

Enter Location

Step 2: Select Provider Office to be Assigned

Dentist NameOffice LocationMore InfoSelect

Step 3: Enter Member Details

OFFICE DETAILS


MEMBER DETAILS

Yes

By clicking “Submit”, I affirm that I am a Florida Medicaid enrollee. I acknowledge that use of this form by anyone other than the enrollee named above is considered potentially fraudulent and may be subject to corrective action by the Plan.

Please only click Submit once