Sello de Jimmy Patronis, CFO

Proveedores de Servicios Médicos

Effective July 1, 2023, Maximus is no longer contracted with AHCA as the vendor for independent dispute resolution. They will continue to process any disputes that were submitted to them before July 1, 2023. Please note, all new dispute resolution requests will NOT be processed until AHCA has selected a new vendor.

The Department of Financial Services (DFS) reviews alleged prompt pay claim payment violations pursuant to s. 627.6131 y 641.3155, Florida Statutes. A summary of the timelines insurance companies and Health Maintenance Organizations (HMO) are required to meet is available under "Additional Information". Claims not paid or denied by the insurance company or HMO in accordance with Florida regulations should be submitted with written documentation indicating the claims were received by the health plan.

Si se determina que su reclamación se encuentra dentro del alcance de la autoridad regulatoria del DFS, se le pedirá que envíe hasta cinco de sus reclamaciones pendientes de cada compañía. Si fuera necesario, le solicitaremos reclamaciones o documentación adicionales.

Under s. 408.7057, Florida Statutes, claims which involve a dispute regarding whether payment should be made or the amount of a payment, should be referred to con-cmcu@ahca.myflorida.com. The Agency for Health Care Administration (AHCA) does not have an active vendor to administer the Statewide Provider and Health Plan Claim Dispute Resolution Program. However, AHCA is in the process of procuring a new vendor. Any new disputes will NOT be processed until a new vendor has been contracted. Medical providers inquiring about disputes filed prior to July 1, 2023, may call Maximus, the previous vendor at that time, toll free at 1-866-763-6395.

reading glasses and pen on paper health form
Atención: Todos los Proveedores de Servicios Médicos

El DFS no tiene autoridad sobre los siguientes contratos:

  1. Contracts purchased in a state other than Florida. If the contract was purchased in a state other than Florida, you should contact that state’s Department of Insurance. You can access the appropriate state’s contact information on the National Association of Insurance Commissioners’ website at https://content.naic.org/state-insurance-departments.

  2. Self-insured federal government employee contracts.

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

  4. Reclamaciones por servicios Odontológicos Prepagados (contractuales).

Información Adicional

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