Medical Billing Services in Florida
Florida runs on Medicare. With the nation's deepest Medicare Advantage penetration, a statewide managed-Medicaid program, and Florida Blue anchoring the commercial side, FL billing is a specialty of its own, and it's ours.
Get a Free FL Revenue AnalysisPRMS Billing Solutions provides full-cycle billing and revenue cycle management for Florida providers, from Miami-Dade and Broward groups to Tampa Bay, Orlando, Jacksonville, and Panhandle practices. Florida's payer profile is dominated by seniors: original Medicare plus an enormous Medicare Advantage population, layered over the Statewide Medicaid Managed Care (SMMC) program and a Florida Blue-led commercial market. We manage eligibility, coding, claims, denials, AR, and credentialing across every one of those lanes.
Medicare billing in Florida
Florida Part B claims are processed by First Coast Service Options, the Medicare Administrative Contractor for Jurisdiction N, headquartered in Jacksonville. We file to First Coast daily and scrub against its local coverage determinations. The bigger Florida story is Medicare Advantage: Humana, UnitedHealthcare, Aetna, and Devoted Health hold huge FL enrollments, and every MA plan has its own auth rules and claim address. We confirm MA enrollment at eligibility on every senior patient, because in Florida, assuming "original Medicare" is the fastest way to a denial.
Florida Medicaid (SMMC) billing
Florida Medicaid runs through the Statewide Medicaid Managed Care (SMMC) program under AHCA, with nearly all members enrolled in managed-care plans: Sunshine Health (Centene), Humana Healthy Horizons, Simply Healthcare, Molina, and Community Care Plan among them, varying by region. Fee-for-service claims allow up to 12 months, but the MCOs set their own, shorter windows, commonly 180 days. We verify each member's SMMC plan and region before the visit and file inside the plan's own clock.
Commercial payers we bill in Florida
Florida Blue (GuideWell) is the state's dominant commercial payer, and its edits and appeal tracks are core knowledge for any FL biller. Around it we bill UnitedHealthcare, Aetna, Cigna, Humana's commercial products, Oscar (active in FL's huge ACA marketplace), and AvMed. Florida's individual-marketplace population is the largest in the country, which means high-deductible plans and patient balances, so disciplined eligibility checks and point-of-service estimates matter more here than almost anywhere.
Specialties we serve across Florida
We bill 25+ specialties across Florida, led by the fields its senior-heavy market runs on: cardiology, orthopedics, dermatology (enormous in FL), ophthalmology, pain management, urology, and urgent care.
Why Florida practices choose PRMS
Florida practices bleed revenue in three places: MA claims filed to original Medicare (or to the wrong MA plan), SMMC claims denied for missing plan-specific authorization, and marketplace patients whose deductible balances go uncollected. All three are front-end problems, and our eligibility-first workflow prevents them before the claim exists. Denials that still happen get appealed, not written off. Credentialing with Florida Blue, SMMC plans, and every major FL payer is free for billing clients.
Florida medical billing FAQs
Do you handle Medicare Advantage billing in Florida?
Yes, and in Florida that is most of the Medicare book. We verify each patient's MA plan (Humana, UHC, Aetna, Devoted, and others) at eligibility, obtain plan-specific authorizations, and file to the plan's correct claims address, which prevents the misrouting denials FL practices see constantly.
Which Medicaid plans do you bill in Florida?
All SMMC managed-care plans, Sunshine Health, Humana Healthy Horizons, Simply Healthcare, Molina, Community Care Plan, and the rest, verified per member and region before the visit.
Which Medicare contractor covers Florida?
First Coast Service Options (Jurisdiction N) processes Florida Part B claims. Its local coverage determinations are built into our claim scrubbing.
Do you serve practices across the whole state?
Yes, South Florida, Tampa Bay, Orlando, Jacksonville, and the Panhandle. The service is fully remote and runs inside your existing EHR or practice-management system.
Related services
Explore our full medical billing & RCM services, denial management, and provider credentialing & payer enrollment (free for billing clients), or browse all 25+ specialties we bill and other states we serve.
See what your Florida practice is leaving on the table
Get a free, no-obligation revenue analysis. We measure your denial rate, days in AR, and recoverable revenue, specific to your payers.