Medical Billing Company in Florida

Mukesh MakwanaFounder & CEO · 8+ years hands-on in medical billing & RCM · Reviewed October 1, 2026

A medical billing company for a Florida practice, especially a behavioral health practice, has to work inside Florida's own system: most Medicaid patients are in Statewide Medicaid Managed Care plans that cover behavioral health, the rest are billed fee-for-service to the state, and commercial health insurers must follow Florida's prompt pay statute, which sets short payment deadlines and a 6-month filing window. Sterling Global Solution LLC supports Florida practices remotely, so each Medicaid claim reaches the right plan and each commercial claim beats the 20-day and 6-month clocks.

Florida Medicaid: managed care first

According to the Florida Senate's November 2025 analysis of Medicaid provider legislation, approximately 72.7 percent of Florida Medicaid recipients receive services through a managed care plan contracted with the Agency for Health Care Administration (AHCA) under the Statewide Medicaid Managed Care (SMMC) program, citing AHCA's enrollment report as of September 30, 2025. The other 27.3 percent receive services through fee-for-service, where providers contract directly with AHCA and bill AHCA.

SMMC 3.0: AHCA awarded and executed new SMMC contracts in October 2024 and rolled out SMMC 3.0 on February 1, 2025.
Components: Managed Medical Assistance (MMA), Long-Term Care Managed Care and the Prepaid Dental Health program.
Regions: the program is organized into Regions A through I, defined in section 409.966(2), Florida Statutes.

Behavioral health in Florida Medicaid

The same analysis lists behavioral health services among the services MMA plans are required to cover, and describes the SMMC benefit package as covering acute, preventive, behavioral health, prescribed drugs, long-term care and dental services. For a therapy, psychiatry or ABA practice, that means most Florida Medicaid behavioral health claims go to a managed care plan, not to the state, and each plan applies its own authorization rules, provider manual and appeal process.

Practical consequences for behavioral health providers:

Confirm the patient's plan and region on every visit, since a patient's plan can change.
Track authorizations per plan, with session counts and end dates.
Bill fee-for-service patients to AHCA, and managed care patients to their plan.
Keep state Medicaid enrollment current: federal rules (42 CFR 438.602(b)) require states to screen and enroll all network providers of their Medicaid managed care plans, so plan credentialing depends on it.

See how we bill for behavioral health and therapy practices, psychiatry and ABA providers.

Florida prompt pay rules for health insurers (section 627.6131)

For health insurers subject to section 627.6131, Florida Statutes, the statute sets, in summary:

Electronic claims: electronic acknowledgment within 24 hours after the beginning of the next business day after receipt, and within 20 days after receipt the insurer must pay the claim or notify the provider that it is denied or contested. Failure to pay or deny a claim within 120 days after receipt creates an uncontestable obligation to pay it.
Paper claims: acknowledgment within 15 days after receipt (or electronic access to claim status), and within 40 days after receipt the insurer must pay the claim or notify the provider that it is denied or contested.
Filing to the primary insurer: within 6 months after discharge for inpatient services or the date of service for outpatient services, and after the provider has been given the correct name and address of the patient's insurer.
Filing to the secondary insurer: within 90 days after the primary insurer's final determination.

Contested claims require the insurer to send an itemized list of the additional information it needs, so answering those requests quickly keeps the claim moving.

Eligibility verification (EV), benefits verification (BV), prior authorizations, and denial management at no cost for your first 30 days.

30-Day Free Trial

What this means for a Florida practice

Submit electronically, so the 20-day action deadline and next-day acknowledgment apply.
Track every commercial claim against the 6-month filing window and every secondary claim against the 90-day window.
Answer contested-claim information requests the same week.
Identify Medicaid patients' SMMC plan and region before the visit, and keep plan authorizations current.

Specialties we bill for Florida practices

We bill for Florida behavioral health practices and for fertility clinics, cardiology, orthopedic and OB-GYN practices, and private and small practices across specialties.

How Sterling Global Solution LLC works with Florida practices

Before each visit we confirm the patient's SMMC plan or commercial coverage and secure any authorization that plan requires. Claims go out electronically, contested-claim requests are answered within days, and secondary claims are filed well inside the 90-day window. New clinicians are enrolled with Florida Medicaid and credentialed with each SMMC plan they will serve; new billing clients get free credentialing for 3 insurance payers. Start with our 30-Day Free Trial.

Frequently asked questions

Do you provide medical billing for Florida practices, including behavioral health?

Yes. Sterling Global Solution LLC bills for Florida practices remotely, including therapy, psychiatry and ABA practices, with SMMC plan rules and Florida prompt pay deadlines built into claim filing and follow-up.

How many Florida Medicaid patients are in managed care?

According to the Florida Senate's November 2025 analysis, approximately 72.7 percent of Florida Medicaid recipients receive services through Statewide Medicaid Managed Care plans contracted with AHCA, citing AHCA enrollment data as of September 30, 2025.

Do Florida Medicaid managed care plans cover behavioral health?

Yes. Behavioral health services are among the services Managed Medical Assistance plans are required to cover under the SMMC program.

How fast must Florida health insurers act on a claim?

Under section 627.6131, Florida Statutes, within 20 days after receipt for electronic claims and 40 days for paper claims, the insurer must pay the claim or notify the provider that it is denied or contested.

What is the timely filing limit for Florida health insurers?

Claims must be sent to the primary insurer within 6 months after discharge or the outpatient date of service, once the provider has the insurer's correct name and address, and to the secondary insurer within 90 days after the primary insurer's final determination.

Sources

The Florida Senate, Committee on Health Policy, Bill Analysis and Fiscal Impact Statement, SB 40 (Medicaid Providers), November 17, 2025: SMMC enrollment shares, SMMC 3.0 dates, components, covered services and regions (citing AHCA enrollment data as of September 30, 2025, and section 409.966(2), F.S.).
Florida Statutes, section 627.6131: acknowledgment, payment and filing deadlines for health insurers.
Code of Federal Regulations, 42 CFR 438.602(b): state enrollment of managed care network providers.

This summarizes official sources and is not legal advice. HMO claims follow a separate statute; check your contracts. How we verify this guidance.

Medical Billing Company for Florida Practices, Including Behavioral Health