Florida billing runs through one of the most managed Medicaid markets in the country, layered with very high Medicare Advantage penetration, especially in South Florida, and a dominant commercial carrier. A practice that bills every payer the same way will lose revenue to authorization rules and plan-specific requirements it never saw coming.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Florida practices of every specialty, built around the state’s actual payers and programs.
Florida’s payer landscape
Florida Medicaid runs through the Statewide Medicaid Managed Care (SMMC) program, including the Managed Medical Assistance (MMA) program. Medicaid patients are assigned to managed care plans, so practices bill the plan, not the state directly. Major SMMC plans include Sunshine Health (Centene), Simply Healthcare Plans (Anthem), Molina Healthcare of Florida, Humana Medical Plan, Aetna Better Health of Florida, UnitedHealthcare Community Plan, and Florida Community Care. Each plan has its own authorization requirements, visit limits, and billing formats.
Commercial coverage is led by Florida Blue (Blue Cross Blue Shield of Florida), alongside AvMed, UnitedHealthcare, Aetna, Cigna, and Humana. Medicare Advantage enrollment is exceptionally high in South Florida, so MA plan authorization and network rules drive a large share of Medicare-related revenue.
What MedPlus RCM handles for Florida practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with SMMC plans, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Miami, Orlando, Tampa, Jacksonville, and Fort Lauderdale, across specialties including primary care, mental and behavioral health, dermatology, cardiology, orthopedics, and physical therapy.
Results Florida practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
Why is Florida Medicaid billing different?
Florida Medicaid runs through SMMC managed care, so you bill a private plan, Sunshine Health, Simply Healthcare, Molina, Humana, or another, each with its own authorization rules and formats. Billing the wrong plan or missing an authorization is the most common failure.
Do you work with Florida SMMC plans?
Yes. We bill SMMC/MMA plans including Sunshine Health, Simply Healthcare, Molina Healthcare of Florida, Humana, Aetna Better Health of Florida, UnitedHealthcare Community Plan, and Florida Community Care, as well as Florida Blue, commercial, and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Florida practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
