Medical Billing for Every Major Payer in Florida
Each payer has its own authorization requirements, network rules, coverage policies, and claims portals. We manage billing for Medicare, Medicaid, and all major commercial payers with dedicated payer-specific workflows.
Why Billing Rules Differ by Payer
Two claims for identical care can be adjudicated completely differently depending on the payer and the specific product the member holds. Authorization requirements, clinical policy, claim routing and appeal deadlines are all set by the plan rather than by the service.
- Member product identified before authorization or submission
- Plan-specific clinical policy applied rather than generic rules
- Claims routed to the correct entity, plan or contractor
- Appeals written against the policy the payer actually cites
Billing Built Around Each Payer's Rules
Generic billing workflows create payer-specific errors. Medicare has LCD/NCD compliance and ABN requirements. Cigna uses eviCore for specialty authorizations. Florida Medicaid bills through SMMC managed care plans, not fee-for-service AHCA. TRICARE requires provider authorization and regional contractor routing. Each payer is different, and billing each one the same way generates denials.
Medsure RCS maintains dedicated billing workflows for every major payer we manage. Prior authorization requests go through each payer's specific platform, eviCore for Cigna, Cohere for Aetna, Availity for Florida Blue, and the CMS Physician Fee Schedule for Medicare. Claims are submitted with payer-correct coding and documentation. Denials are appealed with payer-specific policy language. The result is a higher clean claim rate and fewer revenue gaps from payer rule mismatches.
Payers We Bill
What Our Payer Billing Service Covers
Each capability addresses a specific challenge that arises when billing across multiple payers with different rules.
Payer-Specific Workflows
Each payer has its own prior authorization platform, network rules, and claim submission portal. We maintain separate workflows for every payer we bill so that payer-specific requirements are applied accurately to every claim.
Prior Authorization Management
Authorization requirements differ by payer and service type. We submit and track authorizations through each payer's platform, including eviCore, Cohere, Availity, UHC Portal, and Humana AuthPortal, before the scheduled date of service.
Coverage Policy Compliance
Commercial payers publish medical policies that define coverage criteria by diagnosis code and clinical indication. We check applicable payer policies before claim submission to ensure the correct ICD-10 codes and documentation are in place.
Denial Management by Payer
Payer-specific denial patterns require payer-specific appeal strategies. We prepare appeals with the clinical documentation and coverage policy language each payer's appeal reviewers require.
Payer Performance Reporting
Billing performance broken down by payer, clean claim rates, denial rates, appeal outcomes, and days in AR by payer. Payer-level reporting identifies where reimbursement gaps and denial patterns are concentrated.
Payer Policy Monitoring
Payer medical policies and prior authorization lists change regularly. We monitor updates for each payer we bill and apply revised criteria before the next submission cycle.
Payer-Specific Billing by Carrier
Each payer page covers the specific workflows, authorization platforms, coverage policies, and common billing mistakes for that payer.
Medicare Billing
Part B professional fee billing, LCD/NCD compliance, ABN management, and timely filing tracking.
Learn MoreFlorida Medicaid Billing
SMMC managed care plan billing, AHCA fee-for-service, EPSDT compliance, and dual-eligible sequencing.
Learn MoreUnitedHealthcare Billing
UHC commercial and Medicare Advantage billing, prior auth via UHC portal, and Optum clearinghouse claims.
Learn MoreCigna Billing
eviCore specialty authorization, Cigna medical policy compliance, and commercial network tier accuracy.
Learn MoreAetna Billing
Cohere MSK authorization, Aetna clinical policy bulletins, commercial, MA, and Aetna Better Health Medicaid.
Learn MoreBlueCross BlueShield Billing
Florida Blue plan tier billing, Availity portal, FEP claims, and BlueOptions/BlueSelect network rules.
Learn MoreHumana Billing
Humana Medicare Advantage, AuthPortal authorization, and Humana Healthy Horizons Medicaid billing.
Learn MoreTRICARE Billing
Military health billing across Prime, Select, TRICARE for Life, and Reserve Select with regional contractor routing.
Learn MorePayer Billing for Florida Providers
Florida has one of the highest concentrations of Medicare beneficiaries in the country, making Medicare billing accuracy critical for most Florida practices. The state also operates a mandatory Statewide Medicaid Managed Care program under the Agency for Health Care Administration (AHCA), meaning nearly all Florida Medicaid patients are enrolled in a managed care plan rather than fee-for-service AHCA directly. Each SMMC plan has separate billing requirements, prior authorization rules, and credentialing processes.
Commercial payers including Florida Blue, UnitedHealthcare, Aetna, Cigna, and Humana all operate in Florida with their own network tiers and prior authorization platforms. TRICARE billing is also relevant for Florida providers near military installations. We manage all of these payers with dedicated workflows for Florida-based practices, backed by our denial management and revenue cycle teams.
Loved by Medical Practices
Real reviews from the Medsure RCS Google Business Profile, rated 5.0 out of 5 by 57 Florida healthcare practices and billing teams.
"Our pediatric practice has been with this medical billing company in Florida a while now and they’re wonderful. Billing is accurate, they handle the insurance headaches, collections are steady. Couldn’t be happier."
Sondos Edrees Youssef Ahmed
Pediatric practice · September 2026
"I oversee billing for a large multispecialty group and coordinating everything used to feel completely overwhelming. Having one service that understands the nuances across all our specialties has simplified everything significantly."
Gavin Marshall
Billing lead, multispecialty group · August 2026
"Best billing service we have worked with. Clean claims, fast payments, great communication. Everything you want."
Grady Sinclair
Practice client · August 2026
"Service is good overall but the onboarding took longer than we expected. Took about six weeks before things were really running smoothly for our gastroenterology practice. Once it clicked though the colonoscopy and endoscopy claims started going out clean and we stopped seeing the NCCI bundling rejections that had been killing us. Would still recommend but just be patient in the beginning."
David Leyton
Gastroenterology practice · July 2026
Payer Billing: Frequently Asked Questions
Common questions about payer-specific billing requirements and how we handle them.
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.
Services That Support Payer Billing
Request a Free Payer Billing Consultation
Talk to a Payer Billing Specialist
Contact Medsure RCS to discuss your payer mix and billing challenges. We will review your current denial patterns and payer-specific workflows at no cost.
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