Florida is a two-system state. Florida Medicaid fee-for-service allows 12 months from the date of service — generous by national standards — but the Statewide Medicaid Managed Care (SMMC) program covers most beneficiaries, and each managed care plan sets its own filing deadlines. Some as short as 90 days.
Medical Billing Services Group supports Florida practices remotely, with a US-based team working inside your existing systems. We serve practices in all 50 states from a single remote operation, and Florida accounts get per-plan deadline tracking from the start.
Florida Medicaid billing essentials
Florida Medicaid is administered by the Agency for Health Care Administration (AHCA). The key billing facts:
Fee-for-service: 12 months. Florida Medicaid FFS claims are due within 12 months of the date of service. For secondary claims where the primary payer’s processing runs long, providers generally must submit within 60 days of the primary payer’s final determination, provided the original date of service was inside the 12-month window.
Managed care: plan-specific. Under SMMC, most beneficiaries are enrolled in managed care plans, and each plan publishes its own timely filing policy. For example, Simply Healthcare applies 90 days for participating providers and 12 months for nonparticipating providers. Your actual deadline depends on the plan, your contract status, and the date of service — there is no single Florida Medicaid deadline anymore.
Commercial statutory deadlines. Florida law sets its own clocks for private payers: providers must submit claims to the primary insurer within 6 months (outpatient, from date of service; inpatient, from discharge), and secondary claims within 90 days after the primary insurer’s final determination. PIP auto claims run on a 35-day window.
The practical result: a Florida practice needs a payer matrix with FFS, per-plan MCO, commercial, and PIP deadlines tracked separately.
Where Florida practices lose revenue
Assuming the 12-month rule applies everywhere. The FFS 12-month window is the number everyone remembers — and the number that burns practices when an MCO claim hits a 90-day wall. Plan-specific verification beats assumptions every time.
PIP complexity. Florida’s personal injury protection claims follow auto-insurance rules, not health-insurance rules, with a 35-day filing window and distinct documentation requirements. Practices that treat PIP like commercial claims lose them.
Secondary claim sequencing. With 60-to-90-day secondary windows measured from the primary payer’s determination, secondaries need EOB-date tracking. Monthly batching misses the window.
Eligibility and plan identification. SMMC beneficiaries move between plans. Billing the wrong plan — or FFS when the patient is in managed care — produces instant denials. Our eligibility verification process identifies the exact plan before the claim goes out.
How MBSG supports Florida practices
We provide full medical billing services and revenue cycle management for Florida practices, including:
- Florida Medicaid, SMMC, and commercial claims submission — per-plan deadline tracking across FFS, managed care, commercial, and PIP payers.
- Denial management — root-cause analysis with appeal and corrected-claim workflows matched to each payer’s rules.
- Eligibility verification and prior authorization — plan-level eligibility checks that prevent wrong-payer denials.
- Credentialing and payer enrollment — Florida Medicaid and SMMC plan enrollment, revalidation, and NPI linkage.
- Medical billing audits — coding reviews targeting Florida’s most frequent denial reasons.
- Clearinghouse connectivity — electronic submission with acceptance reports as proof of timely filing.
Smaller Florida practices can use our small-practice billing support. Evaluating a change? See outsourced medical billing.
Specialties we serve in Florida
Billing adapts to specialty coding rules — including behavioral health, cardiology, gastroenterology, oncology, pediatrics, internal medicine, OB-GYN, orthopedic, and urology. Browse all specialties and our services.
Get a Free Billing Audit.
If MCO deadline misses, PIP denials, or secondary backlogs are costing your Florida practice, start with a Free Billing Audit. We review recent claims and show you exactly where revenue is leaking.
Call +1 (307) 396-4107 or email contact@medicalbillingservicesgroup.com. Pricing is quoted in your written proposal after we review your volume and payer mix — see medical billing pricing. Data is handled under our HIPAA safeguards and business associate agreement (HIPAA & security).
Frequently asked questions
What is the Florida Medicaid timely filing limit?
12 months from the date of service for fee-for-service. But most beneficiaries are in SMMC managed care plans that set their own deadlines — some as short as 90 days for participating providers. (Confirm against current AHCA and plan manuals; rules change.)
Does MBSG have a Florida office?
No. We are a remote company serving all 50 states, working inside your existing EHR and practice management system.
Do you handle PIP auto claims?
Yes — PIP claims are worked on their own 35-day clock with auto-insurer documentation requirements, separate from your health-plan workflows.
How do you track so many different deadlines?
Every payer in your mix gets its own filing calendar entry, and claims are worked against the shortest applicable deadline first.
Can you help with Florida Medicaid plan enrollment?
Yes — credentialing and payer enrollment covers AHCA enrollment and SMMC plan contracting.
How do we start?
Get a Free Billing Audit. We analyze your recent claims and denial patterns before you commit to anything.
General educational information, not legal advice or a guarantee of reimbursement. Requirements vary by payer, plan, setting and date of service. Coding references last reviewed 2026-10-08.