Faktirasyon medikal pou chak gwo asirans nan Florid

Yes. We manage billing for Medicare, Florida Medicaid (all SMMC managed care plans), UnitedHealthcare, Cigna, Aetna, Florida Blue (BlueCross BlueShield), Humana, and TRICARE. Each payer has its own prior authorization requirements, networks, and claims submission workflows that we manage separately.

Several major payers use third-party platforms for specific service types. Cigna uses eviCore for radiology and musculoskeletal procedures. Aetna uses Cohere for MSK and surgical authorizations. UHC uses its own Prior Authorization Tool plus specialty programs. We submit through each platform directly and track authorization status before the scheduled service.

Traditional Medicare is a federal program with CMS-published LCDs, NCDs, and the Physician Fee Schedule. Medicare Advantage plans are private insurance plans contracted with CMS, they have their own networks, prior authorization requirements, and covered service rules that differ from traditional Medicare. We manage both through separate billing workflows.

Payer medical policies, covered diagnosis lists, and prior authorization requirements change regularly. We monitor policy updates for each payer we bill and apply updated coverage criteria before claim submission. When a policy change affects a service we are billing, we update our workflow before the next submission cycle.

Yes. TRICARE billing requires provider authorization as a TRICARE-certified provider. We handle TRICARE Prime, Select, TRICARE for Life (as Medicare supplement secondary), and Reserve Select billing. TRICARE for Life claims are always filed after Medicare adjudicates, since TFL is a secondary payer.

Yes. Most Florida Medicaid recipients are enrolled in managed care plans through the Statewide Medicaid Managed Care program. We bill all SMMC plans including Sunshine Health, Simply Healthcare, Molina, Humana Healthy Horizons, and Wellcare, each with separate credentialing and claims workflows.