Medical Billing Company in Florida

ClaimCarePro is a medical billing company in Florida — based in Clearwater and serving practices statewide with claims submission, A/R follow-up, denial management, payer credentialing and PIP billing for 6% of collections.

Florida billing has its own rulebook: First Coast for Medicare, Florida Blue, several Medicaid managed care plans, no-fault PIP under §627.736 and a prompt-pay statute most practices never use. We run medical billing services built around those rules, with 30+ years combined experience and a published price.

Call (727) 580-8186

Last updated October 8, 2026. Reviewed by Jacob Greenberg, founder, ClaimCarePro.

ClaimCarePro at a glance

Based in: Clearwater, FL — serving practices statewide
Price: 6% of collections, $1,000/month minimum
Contract: Month-to-month, no setup fee
Aged / denied A/R: 10% contingency — no recovery, no fee
Credentialing: Flat $250 per payer application
Clean claims: ~95% first-pass clean claim on established accounts
Experience: 30+ years combined
Privacy: We sign a BAA before we see patient data

What a Florida medical billing company actually does

A medical billing company turns the visit your provider documented into money in your bank account. In practice that means six jobs, done every week without gaps: checking eligibility and authorizations before the visit, coding the encounter from the note, submitting a claim the payer's edits will accept, following that claim until it pays, posting the payment and spotting underpayments, and working every denial until it is paid or proven unpayable.

A Florida billing company does all of that against Florida's payer mix. A Clearwater chiropractor may bill Florida Blue, a Medicare Advantage plan, an SMMC Medicaid plan and three auto insurers before lunch, and each one has different filing limits, portals, prior-authorization lists and appeal paths. The work is the same everywhere; the rules it runs on are local.

What it does not do

A billing company cannot fix a note that does not support the code billed, and it should not try. When documentation is the problem, a good biller tells you which notes, which codes and what the payer wants to see, then bills what the record supports. It also cannot bill under a provider who is not enrolled with the payer — which is why enrollment and credentialing sit inside our service rather than beside it.

Who usually hires one

Independent physician practices, therapy and chiropractic clinics, behavioral health groups and specialty practices that have outgrown one in-house biller, lost one, or watched A/R over 90 days climb. The test is simple: if claims are going out late, denials are sitting unworked, or nobody can tell you your collections by payer last month, the billing function is under-resourced.

Medical billing services for Florida practices

One team, one fee, the whole revenue cycle. Each service has its own page with the detail.

Claim submission

Charge entry, eligibility checks, claim scrubbing against payer edits, and electronic submission the same week the visit happens — then status tracking until each claim pays or comes back.

Medical coding

CPT, ICD-10-CM and HCPCS coding reviewed against the note, with modifier logic (25, 59, X-modifiers, GP/GO/GN, AT) checked before the claim leaves.

Denial management

Every denial read, categorized by CARC/RARC code, corrected or appealed, and traced back to the front-desk, coding or enrollment step that caused it.

Insurance A/R follow-up

Aged claims worked oldest-and-largest first, with Florida prompt-pay timelines in hand when a fully insured carrier sits on a clean claim.

Patient collections

Clear statements, payment plans and balance follow-up after insurance has paid its share, so patient responsibility is not left on the books.

Revenue cycle management

The whole loop — registration data, authorizations, charge capture, posting, reporting — run as one process instead of five hand-offs.

Payer credentialing

Payer enrollment, CAQH setup and attestation, re-credentialing and follow-up until the effective date is in writing. Flat $250 per payer application.

PIP / auto-injury billing

Florida no-fault claims billed to §627.736 rules: the 14-day window, the $10,000 benefit ledger, the 35-day billing limit and pre-suit demand letters.

Florida payers: what changes when you bill in this state

Florida's payer mix is unusual: a large Medicare population, heavy Medicare Advantage enrollment, a Medicaid program run largely through managed care plans, and a no-fault auto system that makes PIP a real revenue line for chiropractic, therapy, orthopedic and urgent care practices. Here is how each block works from the billing desk.

Medicare: First Coast Service Options

Original Medicare Part B claims for Florida providers go to First Coast Service Options, the Medicare Administrative Contractor for Jurisdiction N. First Coast publishes local coverage determinations (LCDs) that decide which diagnosis codes support a service, and it runs the enrollment side through PECOS. Two habits prevent most First Coast denials: checking the LCD before billing a covered-only-for-certain-diagnoses service, and keeping each provider's PECOS record — practice location, reassignment, specialty — matched to what the claim says. The federal filing limit is 12 months from the date of service.

Medicare Advantage

A patient who shows a red-white-and-blue Medicare card at check-in may actually be enrolled in a Medicare Advantage plan from Humana, Florida Blue, UnitedHealthcare, Aetna or another carrier. Billing Original Medicare for an Advantage member is one of the most common and most avoidable denials in Florida. We verify the plan on every visit, follow that plan's authorization list, and bill the plan — not First Coast.

Florida Blue

Florida Blue, the state's Blue Cross and Blue Shield plan, sells commercial group, individual (ACA exchange) and Medicare Advantage products, and the network, authorization rules and fee schedule can differ by product. Florida Blue routes provider transactions — eligibility, claim status, authorizations — through Availity. Our habit is to verify the exact product on the card, not just "Blue," before the visit, and to check authorization requirements for imaging, therapy and procedures before the claim exists.

Medicaid: the SMMC plans

Most Florida Medicaid members are enrolled in the Statewide Medicaid Managed Care (SMMC) program, administered by the Agency for Health Care Administration (AHCA). That means you bill the member's plan — for example Sunshine Health, Humana Healthy Horizons in Florida, Simply Healthcare or Molina Healthcare of Florida — not Medicaid directly. Each plan keeps its own provider manual, authorization list, claim address or payer ID, and filing limit. Two Florida-specific traps:

Plans require the rendering provider to be enrolled or registered with Florida Medicaid. A lapsed Medicaid ID denies claims at every SMMC plan at once.
Members change plans. Eligibility checked last month is not eligibility today — we check it on every date of service.

Commercial carriers and the self-funded question

UnitedHealthcare, Aetna, Cigna and Humana commercial plans are common across the state. Before using Florida's prompt-pay statute on a slow claim, we check whether the plan is fully insured (regulated by Florida insurance law) or a self-funded employer plan, which generally falls under federal ERISA rules instead. The member card and the claim response usually tell you which; we keep track so appeals cite the right authority.

Florida timely-filing and prompt-pay deadlines

These are the deadlines a Florida billing office lives by. Each row cites the federal regulation or Florida statute it comes from. Medicare Advantage, SMMC plans and many commercial contracts set their own limits in the provider agreement — those win for that plan, so check your contract rather than assuming a number.

Florida claim filing and payment deadlines by payer type
Payer / situation	Deadline	Source
Original Medicare (First Coast Service Options, Jurisdiction N)	12 months from the date of service	42 CFR §424.44
Florida Medicaid fee-for-service	12 months from the date of service	42 CFR §447.45; AHCA Provider General Handbook
Fully insured commercial plans regulated in Florida	Submit within 6 months of the outpatient date of service (or inpatient discharge)	Fla. Stat. §627.6131(3)(b)
Same carriers — electronic claim response	Pay, deny or contest within 20 days; pay or deny within 90 days; unpaid at 120 days becomes an uncontestable obligation	Fla. Stat. §627.6131(4)
Same carriers — paper claim response	Pay, deny or contest within 40 days; pay or deny within 120 days; uncontestable at 140 days	Fla. Stat. §627.6131(5)
Overdue commercial payments	12% simple interest per year	Fla. Stat. §627.6131(7)
Florida PIP (auto no-fault)	Bill only services rendered within the prior 35 days; benefits overdue 30 days after written notice of the loss	Fla. Stat. §627.736

How we use the prompt-pay statute

Florida's prompt-pay law, §627.6131, gives a provider leverage most practices leave unused. When a fully insured carrier has held a clean electronic claim past 20 days without paying, denying or asking for information, the claim is out of compliance — and a payment that finally arrives late is owed simple interest at 12% a year. Health maintenance organizations have a parallel statute, §641.3155. We track the receipt date of every claim so that a follow-up call can name the statute and the day count instead of asking politely for a status.

The same statute runs the other way: the 6-month submission window in §627.6131(3)(b) means a claim sitting unbilled in a work queue can lose its protection entirely. That is why we submit within days of the visit, not at month-end. This is billing practice, not legal advice; for disputes that need counsel, talk to a Florida health care attorney.

PIP and no-fault billing in Florida

Florida is a no-fault state: after a car accident, the injured person's own Personal Injury Protection coverage pays first, regardless of who caused the crash. For chiropractic, physical therapy, orthopedic and urgent care practices, PIP claims follow a different rulebook from health insurance, written into Florida Statute §627.736. The parts that drive billing:

The 14-day window. Initial treatment must begin within 14 days of the accident, from a provider type the statute lists, or PIP does not pay.
The $10,000 benefit — or $2,500. Medical benefits are capped at $10,000, and drop to $2,500 when a qualifying provider determines the patient did not have an emergency medical condition. That determination changes how long care can be billed to PIP.
80% of reasonable expenses. PIP pays 80% of reasonable, medically necessary charges, and carriers commonly limit reimbursement using the statutory schedule tied to 200% of the Medicare Part B participating physician fee schedule.
The 35-day billing rule. Statements go on a CMS-1500 (or another approved standard form), and a provider cannot bill PIP for services rendered more than 35 days before the statement is submitted.
Overdue at 30 days. Benefits become overdue if not paid within 30 days after the insurer receives written notice of the covered loss. Before suing over an overdue claim, the statute requires a written demand letter, and the insurer gets 30 days to pay after receiving it.

Because the $10,000 benefit is shared across every provider treating the same patient, we keep a running benefit ledger per patient and update it as explanation-of-benefits forms post. When PIP exhausts, coordination moves to MedPay, then health insurance, then any letter of protection — in that order. Our Florida PIP billing page walks through that waterfall in detail.

How our Florida billing process works

Six steps, in this order, for every new practice.

1
Free billing audit
We review a sample of your recent claims, your A/R aging and your denial mix, and tell you in plain numbers where money is stuck — before you sign anything.
2
BAA and system access
We sign the Business Associate Agreement, then take user access to your practice management system and clearinghouse. No PHI moves before the BAA.
3
Enrollment check
We confirm every provider is enrolled, linked to the right group NPI and TIN, and current in CAQH with each payer — the silent cause of many Florida denials.
4
Clean submission
Charges are coded, scrubbed against payer edits and submitted electronically, with authorizations and PIP benefit balances checked first.
5
Posting and denial work
ERAs are posted, underpayments flagged, and every denial worked to resolution with its root cause fixed at the source.
6
Monthly reporting
You see collections, A/R by age bucket and denial categories every month — and the 6% fee is calculated from the deposits on that report.

The one performance number we publish

Our clean-claim result is ~95% first-pass clean claim on established accounts — claims accepted by the payer on first submission, after the onboarding period. New accounts start lower while we correct registration data, enrollment links and coding patterns inherited from the previous setup. We publish no other performance figure, and we would rather show you your own numbers in the free audit than quote a statistic about someone else's practice.

Pricing: 6% of collections, with a worked example

ClaimCarePro charges 6% of collections with a $1,000 monthly minimum. Month-to-month, no setup fee, no long-term contract. The fee is calculated on money actually deposited for you — never on billed charges — so if a claim does not pay, we are not paid for it. Full details are on our pricing page.

Practice collecting $20,000 a month

$1,200 / month

$20,000 × 6% = $1,200
$1,200 is above the $1,000 minimum, so the fee is $1,200
The practice keeps $18,800

Practice collecting $60,000 a month

$3,600 / month

$60,000 × 6% = $3,600
Well above the minimum, so the fee is $3,600
The practice keeps $56,400

Where the minimum starts to matter

The $1,000 minimum equals 6% of about $16,667 in monthly collections ($1,000 ÷ 0.06). Above that, you pay exactly 6%. Below it, you pay $1,000: a practice collecting $12,000 in a month would pay $1,000, an effective 8.3%. If your collections sit well under $16,667 most months, run that arithmetic before you hire anyone, including us.

What is priced separately

Aged and previously denied A/R we take over: 10% contingency on what we recover — if nothing is recovered, there is no fee.
Payer credentialing: a flat $250 per payer application (re-credentialing is the same rate), a $1,750 new-practice bundle per provider, and $99 per provider per year for credentialing maintenance. See provider credentialing services.

How to compare quotes

Convert every quote to dollars at your real collections. A lower percentage applied to billed charges can cost more than 6% of collections, because Florida payers — Medicaid plans and PIP carriers especially — often pay well below charges. Ask each company for its fee on last month's actual deposits, its minimum, its setup fee and its exit terms, and put the four numbers side by side.

How to evaluate a Florida medical billing company

Every billing company says it reduces denials and gets you paid faster. These eight questions separate the answers you can hold someone to from the ones you cannot. Ask them of every company you talk to — including us. Our own answers are in the right-hand column where we have them.

Questions to ask a Florida medical billing company
Question to ask	Why it matters in Florida	What a good answer looks like
Is the fee a share of collections, of billed charges, or per claim?	A percentage of billed charges pays the biller whether or not you get paid. Florida PIP and Medicare Advantage claims often pay well below charges, so the base matters.	A percentage of money actually deposited, stated in writing. Ours: 6% of collections, never of billed charges.
What is the monthly minimum, setup fee and term?	A minimum sets your real price when volume dips — after a hurricane week, a provider leave or a slow summer.	A published minimum, no setup fee, and a term you can exit. Ours: $1,000/month minimum, no setup fee, month-to-month.
Who works denials, and do they fix the cause?	An appeal recovers one claim; fixing the registration, coding or enrollment error stops the next hundred.	Every denial worked to resolution, with the root cause reported back to you. That is how we run it.
How do they report clean-claim performance — and on which accounts?	A first-pass number means little without its definition. New accounts start lower while registration and coding habits get fixed.	A defined metric with its scope stated. Ours: ~95% first-pass clean claim on established accounts.
Can they bill Florida PIP to §627.736 and the SMMC plans by plan?	Auto-injury and Medicaid managed care each run on Florida-specific rules a national template misses.	Named workflows for PIP (14-day rule, benefit ledger, demand letters) and plan-by-plan Medicaid handling.
Is credentialing included, priced separately, or not offered?	A biller who cannot fix an enrollment problem will keep re-submitting claims that deny for it.	A published per-application price and follow-up to a written effective date. Ours: $250 per payer application.
Will they sign a BAA before any data moves?	HIPAA requires a Business Associate Agreement before a billing company handles PHI for you.	Yes, signed before access is granted. We sign one with every practice.
What happens to your data and open A/R when you leave?	Termination fees, fee tails on post-exit payments and slow data exports are where billing contracts get expensive.	A plain exit clause: notice period, who works open claims, and a full data export with no hostage fee.

Where we fit — and where we don't

We fit independent Florida practices and groups that want one team to own the full cycle — coding, claims, denials, A/R, credentialing and PIP — at a published percentage. We are a service, not software: if you want a billing tool for your own staff to run, a software vendor is the better match. And if your monthly collections sit well under about $16,667, the $1,000 minimum makes our effective rate higher than 6%; the free audit will show whether that still pays for itself in your case.

Switching medical billing companies without losing A/R

Most practices that call us already have a biller. The risk in switching is not the new company — it is the claims in the middle: submitted but unpaid, denied but unworked, or never billed at all. A clean switch is a plan for those claims, written down before notice is given.

Contract red flags to read for first

Fees on billed charges rather than collections.
Long notice periods or auto-renewal that lock you in for another year if you miss a date.
Termination fees or a "tail" that keeps charging a percentage on payments received after you leave.
No data-export clause, or an export fee — your claim history, A/R aging and payer correspondence belong to your practice.
No signed BAA. If one is missing, fix that first, whichever company you stay with.

The transition, step by step

Read the termination clause and note the notice period and any tail.
Pull a current A/R aging report and the open-denial list from the outgoing biller before notice is given.
Decide who works what: the outgoing biller on claims it submitted, or ClaimCarePro on everything — older A/R can move to our 10% contingency.
Sign our BAA and grant user access to your practice management system and clearinghouse.
Update ERA and EFT enrollment with each payer if remittances or deposits are routed through the old company.
Pick a cutover date of service: charges on or after it are ours from the first claim.
Reconcile the first month against your bank deposits so nothing fell between the two companies.

The free audit covers steps 1 and 2 with you, so you know what is outstanding before anyone is told anything.

Specialties we bill in Florida

Each specialty has its own codes, modifiers and payer habits. Start with yours, or see all specialties.

Cardiology billing Chiropractic billing Dermatology billing Mental Health billing Nephrology billing Neurology billing OB-GYN billing Personal Injury / PIP billing Physical Therapy billing Podiatry billing Primary Care billing Psychology billing Pulmonary billing Radiology billing Surgery billing Urology billing

Don't see your specialty? — we bill for all medical specialties.

Where we work in Florida

ClaimCarePro is based in Clearwater, FL — (727) 580-8186 — and serves practices statewide. These city pages cover each local market:

Medical billing in Clearwater, FL

Serving Clearwater, Tampa, St. Petersburg, Largo, Dunedin, Safety Harbor, and surrounding Tampa Bay areas by traveling to your location.

Medical billing in Tampa, FL

Serving Tampa, Clearwater, St. Petersburg, Brandon, Riverview, Wesley Chapel, and surrounding Tampa Bay areas by traveling to your location.

Medical billing in Sarasota, FL

Serving Sarasota, Bradenton, Venice, North Port, Englewood, and surrounding Sarasota County areas by traveling to your location.

Medical billing in St. Petersburg, FL

Serving St. Petersburg, Clearwater, Tampa, Largo, Pinellas Park, Gulfport, and surrounding Pinellas County areas by traveling to your location.

Medical billing in Orlando, FL

Serving Orlando, Kissimmee, Winter Park, Altamonte Springs, Lake Mary, and surrounding Central Florida areas by traveling to your location.

Medical billing in Fort Lauderdale, FL

Serving Fort Lauderdale, Miami, Hollywood, Pompano Beach, Deerfield Beach, and surrounding South Florida areas by traveling to your location.

Medical billing in Miami, FL

Serving Miami, Miami Beach, Coral Gables, Doral, Hialeah, and surrounding Greater Miami areas by traveling to your location.

Medical billing in Jacksonville, FL

Serving Jacksonville, Jacksonville Beach, Ponte Vedra Beach, Orange Park, St. Augustine, and surrounding Northeast Florida areas by traveling to your location.

Practice somewhere else in Florida? — we serve practices across Florida.

Florida medical billing: frequently asked questions

How much do medical billing companies charge in Florida?

Most Florida billing companies charge a percentage of what they collect, a flat monthly fee, or a per-claim fee. Compare what you pay per dollar actually collected. ClaimCarePro charges 6% of collections with a $1,000 monthly minimum, month-to-month, with no setup fee. At $20,000 collected in a month, the fee is $1,200.

What is Florida's prompt-pay deadline for commercial claims?

Under Florida Statute §627.6131, a fully insured commercial carrier must pay, deny or contest an electronic claim within 20 days of receipt (40 days for paper), and must pay or deny it within 90 days (120 for paper). Overdue payments carry 12% simple annual interest. Self-funded employer plans generally fall outside state insurance law.

How does PIP billing work in Florida?

Under §627.736, Florida PIP covers 80% of reasonable medical expenses up to $10,000, or $2,500 without an emergency medical condition finding. Initial care must start within 14 days of the accident. Bills go on a CMS-1500 and are limited to services from the prior 35 days. Unpaid claims become overdue 30 days after written notice.

Do you bill Florida Medicaid managed care (SMMC) plans?

Yes. We bill Florida Medicaid and its Statewide Medicaid Managed Care plans, such as Sunshine Health, Humana Healthy Horizons, Simply and Molina. Each plan sets its own prior-authorization lists, filing limits and portal, so we work from each plan's provider manual and keep your Florida Medicaid enrollment active, which the plans require.

Do you bill Florida Blue?

Yes. Florida Blue commercial, Medicare Advantage and exchange plans each follow different policies, so we verify the exact product on every patient before the visit. We track authorizations, submit electronically, follow claim status, and work Florida Blue denials to resolution. Credentialing with Florida Blue is available for a flat $250 per application.

Does it matter whether my billing company is based in Florida?

It helps. A Florida-based team works Florida's payers every day: First Coast for Medicare, Florida Blue, the SMMC plans and PIP carriers, and knows the state statutes behind prompt-pay and PIP. ClaimCarePro is based in Clearwater, works Eastern time, and answers at (727) 580-8186. Ask any company where its billers actually sit.

How long does it take to switch medical billing companies?

The timeline depends on your current contract's notice period and on payer paperwork, especially ERA and EFT enrollment changes. We start with a free audit, take system access, set a cutover date, and decide who works older A/R. New claims can go out as soon as access is in place, and the plan is built so claim submission never pauses.

Can you handle payer credentialing for Florida providers?

Yes. Payer enrollment is a flat $250 per payer application with follow-up until approval, and a new-practice bundle is $1,750 per provider. Payer-published timelines include up to 14 calendar days for UnitedHealthcare, 60 days or less for Florida Medicaid, 45 to 60 for Cigna and 30 business days for Florida Blue.

Is there a long-term contract or setup fee?

No. ClaimCarePro billing is month-to-month with no setup fee and no long-term contract. The fee is 6% of what we collect for you, with a $1,000 monthly minimum. Aged or previously denied A/R we take over is worked on a 10% contingency: if nothing is recovered, there is no fee.

Do you sign a Business Associate Agreement (BAA)?

Yes. ClaimCarePro signs a Business Associate Agreement with every practice before we receive any protected health information. HIPAA requires one whenever a billing company handles patient data on a covered entity's behalf. If a billing company hesitates to sign a BAA, treat that as a reason not to hand over your patient records.

Which EHRs and practice-management systems do you work in?

We work in Practice Fusion, EZClaim and NextGen, including HealthFusion. Tell us which EHR or practice-management system your practice uses and we will confirm whether we work in it before you sign anything. Every practice we work with signs a Business Associate Agreement before we touch protected health information.

See where your Florida claims are stuck

The free billing audit reviews your recent claims, A/R aging and denials, and shows you in dollars what is outstanding — before you sign anything.

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