Florida Medicaid — Florida Medicaid (SMMC — Statewide Medicaid Managed Care)
| Program name | Florida Medicaid (SMMC — Statewide Medicaid Managed Care) |
|---|---|
| Provider portal | https://portal.flmmis.com |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Florida Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Florida
The Blue Cross Blue Shield Association licensee in Florida is Florida Blue (Blue Cross and Blue Shield of Florida). This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in Florida
The dominant commercial insurers operating in Florida, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Florida
Florida Medicaid (SMMC — Statewide Medicaid Managed Care) contracts with the following managed-care organizations to administer Medicaid benefits in Florida. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Florida
First Coast Service Options, Inc. is the Medicare A/B MAC for Florida: Part A and Part B fee-for-service claims from Florida go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 149 active LCDs from these contractors apply to Florida claims.
- First Coast Service Options, Inc.
A/B MAC (Part A and Part B claims)
- CGS Administrators, LLC
DME MAC (durable medical equipment and supplies)
- Palmetto GBA
Home health and hospice MAC
Selected active First Coast Service Options, Inc. policies for Florida
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L36377 Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities
- L34976 Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
- L38805 Colon Capsule Endoscopy (CCE)
- L33252 Psychiatric Diagnostic Evaluation and Psychotherapy Services
- L37561 Cystatin C Measurement
- L33405 Polysomnography and Sleep Testing
- L33411 Surgical Management of Morbid Obesity
- L33583 Diagnostic and Therapeutic Esophagogastroduodenoscopy
- L33618 Major Joint Replacement (Hip and Knee)
- L33674 Duplex Scanning
- L33695 Non-invasive Extracranial Arterial Studies
- L33766 Visual Field Examination
Equipment, home health and hospice policies that apply in Florida
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Florida billing
- FL HB-221 (2016, balance billing protections / surprise bill dispute)
- FL Statute §627.6131 (prompt pay for commercial claims; clean claim 20 days)
- FL Statute §641.3155 (HMO prompt payment of claims)
Provider licensing & enrollment in Florida
Providers enroll with FL Medicaid via FL MMIS Web Portal Provider Enrollment. Each SMMC MCO requires separate credentialing contract.
Major health systems headquartered in Florida
| Health system | Headquarters |
|---|---|
| AdventHealth | Altamonte Springs, FL |
| Baptist Health South Florida | Coral Gables, FL |
| Memorial Healthcare System | Hollywood, FL |
| Jackson Health System | Miami, FL |
| Orlando Health | Orlando, FL |
Frequently asked questions — Florida billing
What is the Florida Medicaid program called?
Florida's Medicaid program is known as Florida Medicaid (SMMC — Statewide Medicaid Managed Care). Providers enroll and manage claims through the provider portal at https://portal.flmmis.com.
What is the Florida Medicaid timely filing limit?
Florida Medicaid (SMMC — Statewide Medicaid Managed Care) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Florida's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Florida Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Florida Medicaid (SMMC — Statewide Medicaid Managed Care). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Florida?
The dominant commercial payers in Florida include UnitedHealthcare, Aetna, Humana, Cigna, along with the BCBS licensee Florida Blue (Blue Cross and Blue Shield of Florida). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Florida?
Florida Medicaid (SMMC — Statewide Medicaid Managed Care) contracts with 6 Medicaid MCOs tracked in the QuickIntell registry, including Centene, Humana, Anthem (Elevance Health), Molina Healthcare, Aetna. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Florida?
Florida has 3 tracked state-level statutes that affect medical billing and RCM: FL HB-221 (2016, balance billing protections / surprise bill dispute); FL Statute §627.6131 (prompt pay for commercial claims; clean claim 20 days); FL Statute §641.3155 (HMO prompt payment of claims). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Florida with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Florida Medicaid (SMMC — Statewide Medicaid Managed Care) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Florida Medicaid and the member ID card before submission.