Florida Prompt Pay Law: Payment Deadlines for Therapy Claims
The Florida prompt pay law gives insurers short, fixed clocks to acknowledge, pay, deny or contest your claim. For a therapist or psychiatrist billing Florida insurers, those clocks tell you exactly when to start following up. This guide explains the electronic and paper deadlines in section 627.6131 of the Florida Statutes, the interest rate, who is covered and where to escalate. Check the statute before you rely on any deadline. This is operational guidance, not legal advice.
Electronic claims under the Florida prompt pay law
Section 627.6131 sets the clocks. See the statute. For electronic claims:
- The insurer must acknowledge receipt within 24 hours after the start of the next business day.
- It must pay, deny or contest the claim within 20 days of receipt.
- A claim must be paid or denied within 90 days.
- If the insurer does not act within 120 days, it has an uncontestable obligation to pay.
Keep your clearinghouse acceptance report for every Florida prompt pay law deadline. It proves the receipt date.
Paper claims under the Florida prompt pay law
- The insurer must acknowledge receipt within 15 days.
- It must pay, deny or contest within 40 days.
- It must pay or deny within 120 days. The uncontestable obligation to pay arrives at 140 days.
When an insurer contests a claim, the notice must include an itemized list of the information it needs. You then have 35 days to respond. The statute defines a claim by the CMS-1500 data set for physicians and for psychologists licensed under chapter 490, so submit complete forms.
Interest under the Florida prompt pay law
An overdue claim bears simple interest of 12 percent per year, counted from when the claim should have been paid, denied or contested. Ask for Florida prompt pay law interest in writing, and keep a log of each claim, its receipt date and the deadline.
Who the Florida prompt pay law covers
The statute applies to major medical expense health insurance policies from group or individual health insurers licensed under chapter 624. That includes preferred provider policies and exclusive provider organizations. HMOs have a parallel rule in section 641.3155, with the same timing and the same 12 percent interest.
Because the Florida prompt pay law is tied to licensed insurers’ policies, ask the plan administrator which rules apply to a self-funded employer plan. Medicare and Medicaid follow their own rules, listed below.
One more rule matters to your cash flow. Under subsection (18), an insurer’s overpayment request to providers licensed under chapters 458, 459, 460, 461, 466 or 490 must come within 12 months of the payment. That covers psychiatrists and psychologists. A note in the statute says the 2025 amendment applies to claims for services provided on or after January 1, 2026.
Private insurers, Medicare and Medicaid: different clocks
| Payer type | Who sets the rule | What to know |
|---|---|---|
| Private insurer or HMO | Florida Statutes and your contract | Respond within 20 days (electronic) or 40 days (paper). Filing limits come from your contract. |
| Medicare | Federal rules | File within one calendar year of the date of service, under 42 CFR 424.44. |
| Florida Medicaid fee-for-service | AHCA | AHCA refers to a 12-month claim submission limit, with exceptions through the portal. See AHCA provider services. Managed care plans set their own limits by contract. |
The statute we reviewed sets no commercial filing deadline for providers, so read each payer contract.
How to follow up on a late claim in Florida
- Confirm the claim reached the insurer and note the receipt date.
- Call the provider line. Our Florida insurance companies contact guide lists the numbers.
- If a deadline passed, write to the insurer and cite the receipt date, the deadline and the interest owed.
- Escalate to the Florida Department of Financial Services (DFS). Its Insurance Consumer Helpline is 1-877-MY-FL-CFO (693-5236), and it has an online form. DFS pages are written for consumers, so ask whether DFS accepts a provider complaint about late payment. See the DFS contact page.
The statute lets the Office of Insurance Regulation fine insurers for claims payment violations, but its text does not describe a provider complaint procedure. See the Office of Insurance Regulation for current routes.
Where MCM South helps
MCM South Medical Billing Service bills for psychotherapists and psychiatrists, and denied claim follow-up is part of that work. We currently serve practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If tracking the Florida prompt pay law deadlines is taking your week, get a free quote or schedule a consultation.
Keep learning: the insurance companies contact by state directory, the billing terms glossary, the CPT and E/M code guide, insurance credentialing, credentialing and network status, the mental health billing FAQ and who we serve. Confirm each deadline with the source.
FAQs
How long does an insurer have to pay under the Florida prompt pay law?
For electronic claims, the insurer must pay, deny or contest within 20 days of receipt. For paper claims, it has 40 days. Section 627.6131 sets longer outer limits of 90 and 120 days.
What interest applies under the Florida prompt pay law?
An overdue claim bears simple interest of 12 percent per year, counted from when the claim should have been paid, denied or contested.
Does the Florida prompt pay law cover HMOs?
Yes. Section 641.3155 sets the same timing and the same 12 percent interest for HMOs.
Can an insurer take back money months later in Florida?
For providers such as psychiatrists and psychologists, an overpayment request must come within 12 months of the insurer’s payment, with the 2025 amendment applying to services on or after January 1, 2026.
