ACCESS Florida Medical Expense Coversheet
Please complete the following fields to generate a Barcode Coversheet. The barcode coversheet is to be used when submitting medical expenses to DCF in order to meet the customer’s Share of Cost in the Medically Needy program.
For the barcode to process without manual intervention, you must:
• Ensure that your printer is set for the highest quality print.
• Check your sending fax device for quality. The barcode
must be clear. It should not be blurry or contain lines or streaks.
• Check the orientation of the fax based on your equipment settings.
Medicaid ID / PIN
Enter ONLY the person's Medicaid ID / PIN. Do not enter a Medicaid Gold Card number or case number.
After you have entered in the information you may click on the button labeled ‘Generate Coversheet’. When you are brought to the screen with the barcode, simply print the webpage. It is very important that you use a
coversheet for bills belonging to a different person. Use of this coversheet will result in the Department receiving the documentation in a more expeditious manner than without the coversheet.