Medical Billing Services in Florida
Billing, coding, credentialing and denial management for Florida practices, with Medicare claims through First Coast Service Options (Jurisdiction JN) and Florida Medicaid handled by people who know the rules.
Medical billing for Florida practices
Florida has one of the largest Medicare populations in the country and some of the highest Medicare Advantage enrollment, so many practices bill more MA plans than traditional commercial payers. Medicare Part B is processed by First Coast Service Options in Jurisdiction N. Florida Medicaid runs through Statewide Medicaid Managed Care, which moved to nine lettered regions in February 2025, and Florida has not expanded Medicaid.
Practices in Miami, Tampa, Orlando and Jacksonville often contract with several Medicaid plans and a long list of MA products, each with its own authorization rules. SFA Solutions works with practices across Florida remotely. Our team works inside your current EHR, submits most clean claims within 24 hours and follows up on Florida Blue, MA and Medicaid plan claims until they are paid or resolved.
Florida at a glance
| Medicare contractor | First Coast Service Options, Jurisdiction JN |
|---|---|
| Medicaid timely filing | Federal Medicaid rules (42 CFR 447.45) require fee-for-service claims to be submitted within 12 months of the date of service; SMMC plans set their own limits in provider contracts, so check each plan's provider manual |
| NP practice authority | Restricted |
| Cities we serve | Jacksonville, Miami, Tampa, Orlando, St. Petersburg, Fort Lauderdale, Hialeah, Tallahassee, Cape Coral, Port St. Lucie |
What Florida billing involves
These are the programs and rules our team works with for Florida claims.
Medicare
First Coast Service Options · JNFlorida Part B claims are processed by First Coast Service Options in Jurisdiction JN. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Florida Medicaid
Florida Medicaid (Agency for Health Care Administration), delivered through Statewide Medicaid Managed Care (SMMC); Florida KidCare for children
Portal: Florida Medicaid Secure Web Portal, operated by AHCA's Medicaid fiscal agent, for provider enrollment and fee-for-service claims
Medicaid managed care
Most members are enrolled in SMMC Managed Medical Assistance plans, which include Aetna Better Health, Community Care Plan, Florida Community Care, Humana, Molina Healthcare, Simply Healthcare, Sunshine Health and UnitedHealthcare. Plan availability varies across the nine regions, A through I.
Timely filing
Federal Medicaid rules (42 CFR 447.45) require fee-for-service claims to be submitted within 12 months of the date of service; SMMC plans set their own limits in provider contracts, so check each plan's provider manual.
Commercial and Medicare Advantage
Florida Blue is the largest commercial carrier, with UnitedHealthcare, Aetna, Cigna and AvMed also common. Humana, UnitedHealthcare and Florida Blue are major Medicare Advantage carriers.
Prompt pay law
Fla. Stat. 627.6131 (insurers) and 641.3155 (HMOs) require payment or notice of denial or contest within 20 days for electronic claims and 40 days for paper claims, with final payment or denial due within 90 days (electronic) or 120 days (paper). Overdue payments carry 12% simple annual interest.
Nurse practitioners
Restricted practiceMost Florida APRNs practice under a supervisory protocol with a physician. APRNs with 3,000 supervised clinical hours and required coursework can register for autonomous practice, limited to primary care such as family medicine, general pediatrics and general internal medicine.
Credentialing
Providers enroll in Florida Medicaid through AHCA's fiscal agent, and each SMMC plan credentials providers separately. Florida Blue, UnitedHealthcare, Aetna and Cigna use CAQH ProView data. Medicare enrollment goes through PECOS with First Coast.
Billing challenges Florida practices face
Medicare Advantage volume
Florida seniors choose Medicare Advantage at high rates, so many practices bill a long list of MA plans with different referral, authorization and coding rules. Risk adjustment also makes complete ICD-10 documentation matter. Plan changes at open enrollment cause a wave of January denials unless coverage is re-verified.
SMMC plan and region changes
The SMMC program moved from eleven regions to nine lettered regions in February 2025, and plan contracts changed in some areas. Members who switch plans cause claims to deny for wrong payer. Checking eligibility for the current plan at each visit helps prevent those losses.
Tight prompt pay timelines to enforce
Florida law requires insurers to respond to electronic claims within 20 days and pay or deny within 90 days. Practices that do not track these dates miss the 12% interest owed on late payments. Our follow-up schedule flags late payers so you can hold them to the statute.
Our services in Florida
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Florida
Florida medical billing questions
What is the timely filing limit for Florida Medicaid?
Federal Medicaid rules require fee-for-service claims to be submitted within 12 months of the date of service, but most Florida members are in SMMC plans that set their own limits by contract. Check each plan's provider manual, since some are shorter. Most clean claims are submitted within 24 hours.
Which Medicaid plans operate in Florida?
SMMC Managed Medical Assistance plans include Aetna Better Health, Community Care Plan, Florida Community Care, Humana, Molina Healthcare, Simply Healthcare, Sunshine Health and UnitedHealthcare. The plans available depend on the region, A through I.
How fast must Florida insurers pay claims?
Under Fla. Stat. 627.6131 and 641.3155, insurers and HMOs must pay or notify you of a denial or contest within 20 days for electronic claims and 40 days for paper claims. Final payment or denial is due within 90 days for electronic and 120 days for paper, and late payments earn 12% annual interest.
Can nurse practitioners practice independently in Florida?
Florida APRNs who complete 3,000 supervised clinical hours and required coursework can register for autonomous practice in primary care. Other APRNs practice under a physician protocol, which payers may request during credentialing.
Get a free billing audit for your Florida practice
We will review your recent claims and denials against Florida payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction N (JN)
- AHCA: new SMMC regions
- AHCA: MMA plans by region
- Fla. Stat. 627.6131 (payment of claims)
- Fla. Stat. 641.3155 (prompt payment of claims, HMOs)
- Fla. Stat. 464.0123 (autonomous practice by an APRN)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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