Medical specialties
Primary and family care
Surgical and procedural
Dental, DME and labs
Revenue cycle · one rate
Front end · before the visit
Patients, insight and growth
Clinical documentation
Revenue operations
Voice automation
Florida medical billing services · Medicare · Medicaid · Commercial
PhysiAssist bills Florida claims to the rules that decide when you get paid: First Coast Medicare, the 20-day electronic claim response rule, 12 percent interest on overdue claims and the limits on insurer overpayment recovery. Coding, claim submission, payment posting, denials and AR follow-up, with a free audit of your recent Florida claims.
Florida clocks we track on every claim
Florida deadlines
| Clock | Rule | What we do |
|---|---|---|
| Electronic claims | A health insurer must pay, or notify the provider of denial or contest, within 20 days of receiving the claim, and must pay or deny it within 90 days of receipt (Fla. Stat. s. 627.6131). | Calendar day 20 and day 90 on every electronic claim. |
| Paper claims | Pay, or notify of denial or contest, within 40 days of receipt; pay or deny within 120 days of receipt. | Submit electronically so the shorter clock applies. |
| Interest on overdue claims | An overdue payment bears simple interest of 12 percent per year. | Calculate interest owed and request it when it is not paid. |
| Overpayment recovery, general | A claim for overpayment must be submitted within 30 months after the insurer paid the claim. | Track insurer overpayment requests against this window. |
| Overpayment recovery, physicians and others | For providers licensed under chapters 458, 459, 460, 461, 466 or 490 of the Florida Statutes, an overpayment claim must be submitted to the provider within 12 months after the insurer paid the claim. | Challenge overpayment requests that arrive after 12 months. |
Sources: Florida Statutes s. 627.6131, CMS Jurisdiction N. Section 627.6131 applies to health insurers; HMOs, Medicaid plans and self-funded plans follow other rules, so we confirm the plan type and terms for each claim. This is billing information, not legal advice.
Payers
| Payer | What to know | What we do |
|---|---|---|
| Medicare Part B | Florida is in Medicare Jurisdiction N, administered by First Coast Service Options (with Puerto Rico and the U.S. Virgin Islands). | Check claims against First Coast policies before submission; work denials and appeals through the First Coast process. |
| Florida Medicaid and Medicaid plans | Filing limits and plan rules vary by program and plan. | Confirm the limit per plan, submit early, and track plan deadlines. |
| Commercial health insurers | The 20-day, 90-day and 12 percent interest rules in s. 627.6131 apply to health insurers. | Calendar due dates and flag late or underpaid claims. |
| HMOs and self-funded plans | Follow different rules from the insurer statute. | Confirm plan type at verification and apply the plan terms. |
What is included
Certified coders code each chart to the payer rules, with a 24-hour chart turnaround and 99% coding accuracy on monthly internal audits.
Clean claims out the door the day charges post, checked against Medicare, Medicaid and commercial edits.
Payments posted against contracted rates; denials worked and appealed inside the payer windows.
Aging claims worked by payer and age, with late and underpaid claims flagged against prompt-pay terms.
Pricing is 2.8% to 5% of net collections, depending on specialty mix, claim volume, payer mix and how clean your current process is. The rate covers coding, claim submission, payment posting, denials and AR follow-up. Front desk, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately. See pricing.
Specialties
Also see denial management, medical coding and end-to-end revenue cycle management.
Under Florida Statutes s. 627.6131, a health insurer must pay, or notify the provider of denial or contest, within 20 days of receiving an electronic claim and within 40 days for a paper claim. It must pay or deny the claim within 90 days for electronic claims and 120 days for paper claims. Overdue payments bear simple interest of 12 percent per year. We calendar each claim against these dates.
In general, an overpayment claim must be submitted within 30 months after the insurer paid the claim. For providers licensed under chapters 458, 459, 460, 461, 466 or 490 of the Florida Statutes, the limit is 12 months. We track insurer overpayment requests against these windows and challenge late ones.
First Coast Service Options is the Medicare Administrative Contractor for Jurisdiction N, which covers Florida, Puerto Rico and the U.S. Virgin Islands, according to CMS. We check claims against First Coast policies before they are submitted.
No. Section 627.6131 covers health insurers. HMOs, Medicaid plans and self-funded employer plans follow other rules or their own contract terms, so we confirm the plan type at eligibility verification.
No. Billing runs remotely through your EHR, clearinghouse and payer portals, and the payer rules come from where your practice and patients are, not from where the billing team sits.
PhysiAssist charges 2.8% to 5% of net collections, depending on specialty mix, claim volume, payer mix and how clean your current process is. The rate covers coding, claim submission, payment posting, denials and AR follow-up. Front desk, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
A certified coder reviews a sample of your recent Florida claims for coding, timely-filing risk, denials and underpayments, and sends a written report you keep.
A free Florida billing audit by a certified coder, with a written report you keep.