jump to home menu jump to vertical menu jump to content jump to footer

Medical Provider Informational Memorandum

Attention: All Medical Providers

The Department of Financial Services (DFS) reviews health claim payment delays pursuant to Florida Statute Sections 627.6131 and 641.3155. A summary of the timeline insurance companies are required to meet is available through this link: Processing Claims in a Timely Manner. Claims not paid or denied by the health insurance plan or Health Maintenance Organization (HMO) in accordance with the above Florida laws should be submitted to us with written proof the claims in question have been received by the insurance plan. Please complete the Medical Provider Request for Assistance Form available on this site and include the requested documentation listed on the form, for our review. We realize we are only requesting five (5) of your outstanding claims; however, we believe a sample of five (5) will assist us in determining a routine business practice. If necessary, we will request additional claims from you. Please do not submit personal medical records.

Under Florida Statute 408.7057, claims that involve a dispute regarding whether payment should be made, or the amount of a payment, should be referred to the Statewide Provider and Health Plan Claim Dispute Resolution Program (Maximus).  Currently, the Agency for Health Care Administration has contracted with Maximus to administer this program.  You may obtain information regarding their claim dispute resolution process by calling 1-866-763-6395.

The DFS does not have authority over the following contracts: 

1)     Contracts purchased in a State other than Florida,

2)     Self-insured Federal Government employee contracts,

3)     Self-insured Employee Welfare Benefit Plan established under the Employee Retirement Income Security Act (ERISA), 

4)     and, Prepaid Dental claims (contractual)

Additional Information: