Medical Billing Services in Florida For Accurate Billing

Most Medicaid patients are in Florida’s Statewide Medicaid Managed Care (SMMC) program, which uses contracted plans for medical, long-term care, and dental services. That managed-care design, plus strong oversight from AHCA, means payer rules and audits can vary by plan and region - so clean, plan-specific submissions matter.

We align workflows to AHCA guidance and payer manuals, run routine self-audits, and maintain HIPAA-ready documentation. Our process standardizes eligibility, authorizations, coding, and attachments per plan so claims are audit-ready before they go out.

Florida’s SMMC 3.0 introduced new contracts and operational updates for Medicaid managed-care plans. For providers, that can mean refreshed claims routing, prior-auth policies, and updated encounter data requirements - so we map your claims to each plan’s latest specs to avoid denials.

Yes. We manage enrollments and re-credentialing with Florida Medicaid plans, Medicare, and major commercial payers such as Florida Blue. We track expirations, CAQH updates, and plan-specific checklists to prevent claim holds and write-offs tied to credentialing gaps.

Florida prohibits balance billing for emergency care and protects members treated at in-network facilities by out-of-network clinicians. We verify network status, apply correct payer rules, and educate front desks on consent and disclosure so you stay compliant and get paid appropriately.

We combine real-time eligibility checks, authorization tracking, and payer-specific claim edits with post-payment analytics. Common Florida denials - missing auths, coding mismatches, and eligibility lapses - are intercepted early; rejected claims are corrected and appealed fast with plan-friendly evidence.

Yes. We bill telehealth under current Medicare and Florida Medicaid policies, including audio-only allowances where permitted. We validate place-of-service, modifiers, and documentation so remote visits get paid like on-site care when rules allow.

We support primary care, behavioral health, cardiology, pediatrics, urgent care, pain management, and more. Each specialty gets payer-specific coding guidance, auth templates, and denial playbooks tailored to Florida plans.

Most practices are live within 5–10 business days. We begin with a complimentary audit, set up payer connections and ERA/EFT, align your EHR/PM settings, and launch with a short parallel-run to verify clean acceptance and payment posting.

We offer transparent percentage or hybrid pricing based on claim volume, specialty, and services (RCM, coding, AR recovery, credentialing). You pay for measurable results - clean submissions, lower denials, and faster reimbursements.