Florida Prompt Pay Law for Therapists: 6 Easy Essentials

The Florida prompt pay law for therapists is a pair of state statutes that set how fast health insurers and HMOs must acknowledge, pay or deny your claims, and how fast you must file them. Section 627.6131 covers health insurers and section 641.3155 covers health maintenance organizations (HMOs). Knowing the clock tells you when to follow up and when a late claim starts earning interest.

What the Florida prompt pay law for therapists covers

Both statutes set deadlines for commercial payers that operate under Florida insurance law. The Florida Department of Financial Services (DFS) says on its medical provider page that it reviews alleged prompt pay violations under both sections. DFS also lists what it does not cover: contracts bought outside Florida, self-insured employee plans under the federal ERISA law, self-insured federal employee contracts, and prepaid dental claims. Ask each payer which rules govern the plan before you rely on the clock.

The six deadlines in the Florida prompt pay law for therapists

The 2026 text of section 627.6131 and the 2026 text of section 641.3155 use the same time frames. Electronic claims run on a shorter clock than paper claims, so file electronically when you can. Add the dates to your follow-up calendar when you send each batch.

Deadline	Electronic claim	Paper claim
1. Payer acknowledges receipt	24 hours after the start of the next business day	15 days (or electronic status access)
2. Payer pays, or says the claim is denied or contested	20 days	40 days
3. You send the information a contest notice asks for	35 days after the notice	35 days after the notice
4. Payer pays or denies	90 days	120 days
5. Unpaid obligation becomes uncontestable	120 days with no action	140 days with no action
6. You file the claim	6 months from the outpatient date of service	6 months from the outpatient date of service

The six-month filing rule applies once you have the patient’s correct insurer name and address. A secondary claim is due 90 days after the primary payer’s final decision. Overdue claim payments bear simple interest at 12 percent a year.

Florida prompt pay law for therapists: private payers, Medicare, Medicaid and state rules

These statutes govern commercial coverage. Keep the other programs in separate notes.

Private payers

Section 641.3155 says its terms cannot be waived by contract. Still read the filing window and appeal deadline in each contract, and see our guide to in-network and out-of-network credentialing for how network status changes your position. A payer dispute can also be an internal appeal: the statutes set 60 days for a payer to finalize its internal review of a provider’s request on contracts made or renewed after October 1, 2002.

Medicare and Medicaid

Medicare.gov says Original Medicare claims must be filed within 12 months. Florida Medicaid plans set their own windows in their provider manuals; Molina’s June 2025 Florida deck says six months. Ask each Medicaid plan which prompt pay rules govern its claims instead of assuming the commercial statutes apply.

State rules

If your claim falls under DFS authority, it asks for up to five outstanding claims per company, with proof the plan received them. Payment or amount disputes under section 408.7057 go to the claim dispute program run by the Agency for Health Care Administration, per the DFS page. Other states have different clocks, so never copy the Florida prompt pay law for therapists into a Georgia or Texas file.

What can I do if a Florida insurer pays late?

Start with proof. Keep the clearinghouse acceptance report and the date the payer received each claim, then call the payer and record the reference number. If the clock has run and the payer is a Florida-regulated insurer or HMO, DFS reviews prompt pay complaints. The Florida prompt pay law for therapists also gives you interest at 12 percent a year on overdue payments, so note the date a claim should have been paid.

What to do Monday morning

1. Pull every electronic claim older than 20 days with no payment or denial. That is the first check under the Florida prompt pay law for therapists.
2. Save the clearinghouse report and received date for each one.
3. Answer every request for more information within 35 days; read the denial on your remittance advice and your CARC and RARC codes.
4. Look up the payer’s line in our insurance companies contact directory and log every call.
5. Track your clean claim rate; clean claims move through the clock faster.
6. Review each month’s payments for shortfalls, using our guide to underpayments.

The short version: Florida prompt pay law for therapists

The Florida prompt pay law for therapists gives payers 20 days (electronic) or 40 days (paper) to pay or contest a claim, and gives you six months to file. Keep proof of receipt, answer requests within 35 days, and know which plans fall outside the statutes.

How MCM South helps

MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims for clients.

Tired of chasing late payers? We can talk through your practice.

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FAQ

Where MCM South works

MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.

This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.