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Division Director

Toma Wilkerson


Division of Rehabilitation and Liquidation
Alexander Building
2020 Capital Circle SE
Suite 310
Tallahassee, FL 32301
1-800-882-3054

Florida Healthcare Plus, Inc.

Claims Information

 

On 1/20/2017 a Court order was signed approving the first Interim Claims Report for the Florida Healthcare Plus, Inc. receivership.  Notices of Determination were sent out on all evaluated claims in classes 2-8. 

An evaluation code is listed on the Notice of Determination which provides the basis of the amount recommended.   These codes are as follows:

Evaluation Code

Evaluation Description

1

THE AMOUNT CLAIMED IS NOT A COVERED EXPENSE ITEM

10

DENIED DUE TO INSUFFICIENT DOCUMENTATION

12

YOUR CLAIM WAS DENIED BECAUSE THE RECEIVER COULD NOT VERIFY COVERAGE CONFIRMATION

14

DUPLICATE CLAIM PREVIOUSLY SUBMITTED

24

THE POLICY WAS UNDERWRITTEN BY ANOTHER COMPANY

41

AMOUNT ALLOWED TO PROVIDER UNDER A DIFFERENT CLAIM ID#  

53

AMOUNT CLAIMED IS RECOMMENDED

55

AMOUNT RECOMMENDED OTHER THAN AMOUNT CLAIMED

58

CLAIM ALREADY PAID

66

TPA ADJUDICATED - MEDICARE

67

TPA ADJUDICATED - MEDICAID

If your Notice of Determination reflects a code of 66 or 67, your claim was adjudicated by a third party administrator (PayerFusion).  The administrator sent out remittance advices monthly as the claims were adjudicated.  The amount claimed and the amount recommended claimant are cumulative totals of the individual claims submitted.  If claims were submitted with multiple NPIs, billing addresses, Medicare and Medicaid coverage they may have been evaluated separately and you may receive more than one notice. 

Please review the information on your Notice of Determination and compare it to your claim submissions and corresponding remittance advices.  If you have questions regarding the evaluation of your claim or matching of the remittance advices of multiple claims, please contact us using the following contact form.

Please note that the objection filing deadline is Monday, April 3, 2017.  Objections filed after the deadline will not be accepted.