Florida provider and health-plan claim dispute support.

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.
• The program concerns qualifying Florida-licensed providers and state-regulated plans. Thresholds, prior resolution efforts, exclusions, and filing timing apply.
• Participation is generally voluntary, with mandatory participation for Statewide Medicaid Managed Care plans when a provider requests review. Disputes solely about late payment or interest are outside this program.

PRP operating scope

One managed workflow from review through outcome.

1. 01

   Review the plan, service, payment or denial, notices, and procedural timing.

2. 02

   Confirm the likely federal or state pathway before initiating work.

3. 03

   Manage negotiation notices, filing steps, deadlines, and communications.

4. 04

   Organize client-supplied records into a clear supporting submission.

5. 05

   Track status, outcomes, and incremental recovery in the client dashboard.