Medical Billing Services in Florida
Florida practices bill First Coast for Medicare Part A and B, AHCA and SMMC plans for Medicaid, and one of the country's largest Medicare Advantage markets. We help keep every payer's rules straight. We support practices in Florida remotely across 15+ specialties.
Who Pays Medical Claims in Florida
The payer groups our team works with every day for Florida practices.
Jurisdiction JN
Florida Medicare Part A and Part B claims go to First Coast Service Options, Inc.. Medicare DME claims go to DME MAC Jurisdiction C (CGS Administrators).
Florida Medicaid
Run by the Agency for Health Care Administration (AHCA).
Managed care plans
Most Florida Medicaid recipients get care through the Statewide Medicaid Managed Care (SMMC) program, which includes Managed Medical Assistance (MMA), Long-Term Care and Dental plans. The plan, not fee-for-service Medicaid, usually handles authorization and claims. We bill and follow up with the state’s Medicaid managed care plans under each plan’s own rules.
Plan lists change. We confirm each patient's current plan at eligibility check. Commercial and Medicare Advantage plans are billed under their own contracts.
Florida Medicaid Billing Rules to Know
Taken from the state program's published provider guidance. Manuals change, so we confirm current rules before each submission.
12-month filing limit
A clean fee-for-service claim must be received by Florida Medicaid or its fiscal agent no later than 12 months from the date of service.
Other insurance first
When a recipient has other insurance (other than Medicare), the claim must be received within 12 months of the date of service or six months from the other payer's payment or denial.
Medicare crossover limit
For Medicare claims crossing over to Medicaid, the filing limit is the greater of 36 months from the date of service or one year from the Medicare payment date.
Source: AHCA Florida Medicaid Provider Reimbursement Handbook, CMS-1500 (Time Limit for Submission of a Claim Form); AHCA Provider Services page (exceptional claims).
What Makes Florida Medical Billing Different
What we watch for on Florida accounts.
Why Florida billing gets complicated
Many Florida patients have Medicare Advantage or SMMC coverage, so the same CPT code can have different authorization rules depending on the card. Dual-eligible patients add another step: Medicare pays first, then the claim crosses over to Medicaid under its own filing limit. We confirm which plan pays first, and which Medicaid plan sits behind it, during eligibility verification, before the patient is seen.
What We Handle for Florida Practices
Take the full revenue cycle or just the parts you need help with.
Eligibility and benefits checks before the visit
Prior authorization requests and tracking
Medical coding and charge review
Claim submission to Medicare, Medicaid and commercial payers
Denial management, appeals and A/R follow-up
Payment posting, patient statements and monthly reporting
Specialties We Support in Florida
15+ specialties served. Pick yours to see how we bill it.
Florida Medical Billing Questions
Short answers to questions we hear from practices.
Who is the Medicare Part A and B contractor for Florida?
Florida is in A/B MAC Jurisdiction N (JN), administered by First Coast Service Options. Medicare DME claims go to the Jurisdiction C DME MAC, CGS Administrators.
What is the Florida Medicaid timely filing limit?
A clean fee-for-service claim must be received within 12 months of the date of service. Different limits apply when there is other insurance or a Medicare crossover, and SMMC plans set their own limits.
What is SMMC?
Statewide Medicaid Managed Care is Florida's managed care program. Most Medicaid recipients are enrolled in an SMMC health plan, so we verify the plan and its authorization rules before the service.
Which specialties do you support in Florida?
We support 15+ specialties, including behavioral health, laboratory, home health, hospice, infusion, sleep medicine, DME, dental, vision and ENT.
Can Salyx RCM work with my Florida practice remotely?
Yes. We support practices in Florida remotely and usually work inside the billing system you already use.
See Where Your Florida Claims Are Getting Stuck
Start with a free billing audit. We review your recent claims, denials and A/R, then tell you what we found.