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Medical Billing Services in Florida

For a Florida practice, most Medicaid billing is plan billing: the Agency for Health Care Administration contracts with managed care plans under the Statewide Medicaid Managed Care program, and most recipients get their services through one of those plans. Medicare claims go to First Coast Service Options. We bill remotely for Florida practices and confirm the rest of each payer's rules from its current policies.

  • Statewide Medicaid Managed Care plan claims, by program component
  • Medicare claims through First Coast Service Options
  • Payer-specific rules confirmed from each plan's current manuals
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Practices we typically see in Florida

Florida practices that see Medicaid patients mostly bill AHCA-contracted SMMC managed care plans rather than Medicaid fee-for-service directly, and bill First Coast Service Options for traditional Medicare.

Statewide Medicaid Managed Care and its three components

The Florida Agency for Health Care Administration (AHCA) is the single state agency that administers Florida Medicaid, and most people on Florida Medicaid get care from a managed care plan that holds an AHCA contract under the Statewide Medicaid Managed Care (SMMC) program.

SMMC is split into three parts: Long-Term Care (LTC), Managed Medical Assistance (MMA) and Dental. A practice billing a Medicaid patient therefore needs to know not just the plan, but which component covers the service.

Official source: Florida AHCA Section 1115 demonstration request (on Medicaid.gov) (external site)

How remote billing works for practices in Florida

We work remotely in your systems and each plan's portal. Access runs through logins your practice issues and controls.

  1. Step 1: Record the SMMC plan and component

    Each Medicaid patient's plan and SMMC component, MMA, LTC or Dental, is recorded before the visit.

  2. Step 2: Load each plan's rules

    Authorization, claim and appeal rules are taken from each SMMC plan's current provider manual.

  3. Step 3: Bill Medicare to First Coast

    Traditional Medicare claims go to the Jurisdiction N contractor; Medicare Advantage claims go to the patient's plan.

  4. Step 4: Work denials by plan

    Denials are tracked plan by plan, since each SMMC plan applies its own policies.

Medicare and other payers for Florida practices

Traditional Medicare Part A and Part B claims in Florida go to First Coast Service Options, the Medicare Administrative Contractor for Jurisdiction N, which also covers Puerto Rico and the U.S. Virgin Islands.

Commercial plans, auto insurers and workers' comp carriers each set their own billing requirements. We work from each payer's current provider manual and contract rather than general rules, and confirm requirements with the payer when a claim needs it.

Official source: CMS: A/B MAC Jurisdiction N (First Coast Service Options) (external site)

Official sources for Florida

Rules change. These are the agencies and contractors we check for the current requirements.

Frequently asked questions

Do Florida practices bill Medicaid directly or through plans?

Mostly through plans. Most Florida Medicaid recipients receive services through a managed care plan contracted with AHCA under the SMMC program.

Official source: Florida AHCA Section 1115 demonstration request (on Medicaid.gov) (external site)

What are the parts of Statewide Medicaid Managed Care?

Managed Medical Assistance, Long-Term Care and Dental. Which one applies depends on the service and the recipient.

Official source: Florida AHCA Section 1115 demonstration request (on Medicaid.gov) (external site)

Which Medicare contractor handles Florida claims?

First Coast Service Options, the Medicare Administrative Contractor for Jurisdiction N.

Official source: CMS: A/B MAC Jurisdiction N (First Coast Service Options) (external site)

How do you handle auto injury and workers' comp claims in Florida?

From each carrier's current requirements and the state agencies' published rules, confirmed when the case begins. We handle these claims as part of the engagement when the practice wants them included.

Do you need to be in Florida to bill SMMC plans?

No. SMMC plan claims and portals are electronic, so the billing can be done remotely. Our team works remotely for practices across the United States.

Related services and nearby states

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Review your Florida Medicaid plan claims

A free audit groups your Medicaid denials by SMMC plan and component, so you can see which plans cause the most rework.

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