Florida practices bill Medicare Part B through First Coast Service Options, but a large share of older patients carry Medicare Advantage plans, Medicaid runs through SMMC managed care, and Florida Blue leads a busy commercial market.
How Medical Billing Works in Florida
Every state has its own mix of payers and rules, and Florida is no exception. These are the points that most often decide whether a Florida claim is paid on the first pass:
- Florida has one of the highest Medicare Advantage enrollment rates in the country, so many "Medicare" patients are actually billed to a private plan with its own prior-authorization and referral rules.
- Most Florida Medicaid patients are enrolled in Statewide Medicaid Managed Care (SMMC) plans, and each plan has its own claim address, edits and timely-filing window.
- Seasonal residents often carry out-of-state coverage, so we verify home-state plans and network status before the visit rather than after the denial.
Our Medical Billing Services in Florida
We run the complete revenue cycle for Florida practices, remotely and inside your existing EHR or practice management system:
- Insurance eligibility and benefits verification before each visit
- Medical coding (CPT, ICD-10-CM, HCPCS and modifiers) by certified coders
- Charge entry and claim scrubbing to catch errors before submission
- Electronic claim submission to Medicare, Florida Medicaid plans and commercial payers
- Denial management and appeals with root-cause tracking
- A/R follow-up on aging claims, worked daily
- Payment posting from ERAs and EOBs, including underpayment checks
- Credentialing and payer enrollment, including AHCA / Florida Medicaid provider enrollment
- Monthly reporting on collections, denials and days in A/R
Who We Work With
Our Florida clients include primary care and internal medicine practices, specialty groups such as dental billing, ENT billing and internal medicine billing, independent laboratories and multi-location clinics. Whether you are in Jacksonville, Miami or a smaller community, you get the same certified coders, the same daily A/R follow-up and the same transparent reporting.
Cities We Serve in Florida
Specialties We Bill For in Florida
Frequently Asked Questions
Who processes Medicare claims in Florida?
Medicare Part B claims for Florida are processed by First Coast Service Options (Jurisdiction N (JN)). We submit, track and follow up on those claims for you, including Medicare Advantage plans, which are billed to the private plan instead.
How do you bill Florida Medicaid?
Florida Medicaid is run by the Agency for Health Care Administration (AHCA), and most members are enrolled in Statewide Medicaid Managed Care (SMMC) plans. We verify the member's plan before the visit and send each claim to the right plan with the right edits.
Which commercial payers do you work with in Florida?
We bill all major commercial payers in Florida, including Florida Blue, UnitedHealthcare, Aetna, Cigna and Humana, plus regional and employer plans.
Which Florida cities do you serve?
We serve practices throughout Florida, with dedicated pages for Jacksonville, Miami, Tampa, Orlando, St. Petersburg, Port St. Lucie, Cape Coral, Hialeah, Tallahassee and Fort Lauderdale. Because billing is done remotely, practices anywhere in the state can work with us.
How do we get started?
Request a free billing audit. We review a sample of your claims, denials and A/R, show you where revenue is being lost and give you a fixed quote — with no obligation.