Pathway overview
Start with the governing plan and claim facts.
Florida’s statewide provider and health-plan claim dispute resolution program assists contracted and noncontracted providers and health plans with qualifying disputes that were not resolved between the parties.
Important distinctions
What provider teams should identify early.
- The Florida program is administered by the Agency for Health Care Administration under section 408.7057.
- Program scope depends on the provider, health plan, dispute, and prior efforts to resolve the claim.
- A Florida claim dispute should not automatically be treated as a federal No Surprises Act matter.
PRP operating scope
One managed workflow from review through outcome.
- 01
Review the plan, service, payment or denial, notices, and procedural timing.
- 02
Confirm the likely federal or state pathway before initiating work.
- 03
Manage negotiation notices, filing steps, deadlines, and communications.
- 04
Organize client-supplied records into a clear supporting submission.
- 05
Track status, outcomes, and incremental recovery in the client dashboard.