Credentialing in Florida
Soft Home Global provides payer enrollment, revalidation and follow-up for Florida practices and billing companies at $2,200 per seat per month. Full time, worked during Florida business hours, inside your own system.
What is specific to Florida
Florida Medicaid is delivered largely through managed care plans, so a single practice may be dealing with six or seven separate payer portals.
Florida’s Medicaid program is Florida Medicaid. Practices with a meaningful Florida Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by First Coast Service Options, jurisdiction JN — not shared with Alabama (Palmetto GBA) or Georgia (Palmetto GBA). CMS publishes the jurisdictions; checked September 2026.
What a credentialing seat does in Florida
Applications, revalidations and payer follow-up, with every enrollment's status visible.
Florida Medicaid is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during Florida business hours, not queued overnight
For the statute behind all of this — Florida’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Florida billing page.
Florida Medicaid, in practice
Near-universal managed care through Statewide Medicaid Managed Care (SMMC). SB 1950 (2022) realigned Florida's counties into nine regions rather than eleven, effective 2025, and AHCA implemented the new SMMC 3.0 program on February 1, 2025 under 2025–2030 plan contracts, so plan rosters and region numbers changed recently and older payer lists are stale. Source: ahca.myflorida.com
Florida gives the biller a hard statutory kill-switch on payer stalling: under Fla. Stat. 627.6131, 'Failure to pay or deny a claim within 120 days after receipt of the claim creates an uncontestable obligation to pay the claim' for electronic claims, and the same language applies at 140 days for non-electronic claims. Very few states convert a payer's delay into an absolute, non-contestable payment obligation. The flip side is a tight filing window on the provider: claims 'must be mailed or electronically transferred to the primary insurer within 6 months' after inpatient discharge or the outpatient date of service, and to a secondary insurer 'within 90 days after final determination by the primary insurer.' Source: FindLaw state code
For enrolment that is not a detail, it is a second application. A carved-out benefit is administered by a different organisation, which credentials separately, on its own timetable, and a provider who is live everywhere else can still be out of network for that one service without anybody noticing until the first claim is denied.
Working Florida hours
Florida runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
One wrinkle worth naming: the western panhandle runs on Central time. If your practice sits on that side of the line, say so on the call and the shift is set to your clock rather than the one most of the state keeps.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Florida hours and nobody else’s.
What it costs in Florida
$2,200
Per seat, per month, in US dollars — $26,400 a year for one full-time person, forty hours a week, on Florida hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Florida run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Florida
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Florida practices?
Yes. Florida accounts are worked during Florida office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Florida?
Florida Medicaid is delivered largely through managed care plans, so a single practice may be dealing with six or seven separate payer portals.
Which Medicare Administrative Contractor covers Florida?
First Coast Service Options, the A/B MAC for jurisdiction JN. It processes Medicare enrollment applications for providers here, and it sends the revalidation notice two to three months before the due date.
When does a Florida payer have to pay a clean claim?
20 days for an electronically submitted claim; 40 days for a non-electronic (paper) claim. Florida Statutes 627.6131 (health insurers). Electronic claims must also be acknowledged within 24 hours of the next business day; paper claims within 15 days. It runs from receipt of a clean claim, so claims held back while a provider’s enrollment is pending have not started it.
How often do Florida providers have to revalidate?
Medicare: every five years, with sixty days to submit once First Coast sends the notice (42 CFR 424.515). Florida Medicaid: federal rule requires the state to revalidate every provider at least every five years (42 CFR 455.414), and the state agency sets the exact schedule. A Medicare revalidation left unanswered deactivates billing privileges, and claims stop with it.
How much does credentialing cost in Florida?
$2,200 per seat per month — $26,400 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Florida queue?
Florida is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Florida Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Florida Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for Florida
- Medical Billing in Florida
- Prior Authorization in Florida
- Certified Payroll in Florida
- Florida certified payroll rules
- Medicare revalidation lookup by NPI
- Why prior authorizations get delayed, and how to stop it
- Seven things that trigger a certified payroll audit
- Days in AR: what the number hides and how to move it
- All prices
Next step
One seat on your Florida work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com