The Florida Medicaid claims address depends on how the patient is covered. Fee-for-Service paper claims go to Gainwell Technologies, the state’s fiscal agent, at a P.O. Box in Tallahassee. Most Florida Medicaid recipients, however, are enrolled in a managed care plan under the Statewide Medicaid Managed Care program, and those claims go directly to the member’s Managed Care Organization at the address printed on the member’s ID card. Sending a managed care claim to the Fee-for-Service P.O. Box, or vice versa, is one of the fastest ways to trigger a rejection and lose weeks on reimbursement.
Fee-for-Service Paper Claims Address
A small share of Florida Medicaid recipients remain in the Fee-for-Service program rather than a managed care plan. Gainwell Technologies LLC processes those claims on behalf of the Agency for Health Care Administration. The CMS-1500 Provider Reimbursement Handbook directs professional paper claims to:
Florida Medicaid
P.O. Box 14597
Tallahassee, FL 32314-4597
That P.O. Box is for professional claims billed on the CMS-1500 form — physician office visits, outpatient services billed by individual practitioners, and similar non-facility charges. Institutional claims from hospitals, nursing facilities, and other institutional providers use the UB-04 form and go to a separate P.O. Box designated in the UB-04 Provider Reimbursement Handbook. AHCA updates these addresses from time to time, so confirm the current destination in the applicable handbook before mailing. Resubmitted or corrected FFS claims go to the same P.O. Box as the original.1Florida Agency for Health Care Administration. Provider Reimbursement Handbook, CMS-1500
Managed Care Organization Claims Addresses
Most Florida Medicaid recipients are enrolled in a plan under the Statewide Medicaid Managed Care program, which includes the Managed Medical Assistance, Long-Term Care, and Dental components.2Family Network on Disabilities. Statewide Medicaid Managed Care – Managed Medical Assistance Program For those members, claims go directly to the MCO, not to Gainwell or AHCA. Each MCO operates its own claims processing center and publishes the mailing address in its provider manual and on the member’s ID card.
These addresses are often out of state. Humana Healthy Horizons in Florida, for example, directs medical claims to:
Humana Healthy Horizons in Florida
Claims Office
P.O. Box 14601
Lexington, KY 40512-4601
Humana routes behavioral health claims to different addresses depending on the service region, with Region A going to Access Behavioral Health in Pensacola and Regions B through I going to Carelon Behavioral Health in Hicksville, New York.3Humana. Contact Us – Humana Healthy Horizons in Florida Other major SMMC plans, including Sunshine Health, Molina Healthcare, Aetna Better Health, and Simply Healthcare, each publish their own claims addresses. Verify the member’s plan enrollment first, then use that plan’s address. A managed care claim sent to the FFS fiscal agent will come back denied or returned.
Submitting Electronically Instead
Electronic submission is the standard for Florida Medicaid and the method AHCA expects for the overwhelming majority of claims. There are two main pathways.
Through a Clearinghouse
For Florida Medicaid FFS claims submitted through a clearinghouse, the payer ID is 77027 for both professional (837P) and institutional (837I) transactions, as well as for electronic remittance advice (835). Eligibility verification (270/271) and claim status inquiries (276/277) use payer ID FLMCD. MCO claims use each plan’s own electronic payer ID; the clearinghouse or MCO provider manual will specify it.
Through the Florida Medicaid Web Portal
AHCA maintains the Florida Medicaid Secure Web Portal at home.flmmis.com, where enrolled providers can submit claims directly, check eligibility, view remittance advices, and manage provider records.4Florida Agency for Health Care Administration. Florida Medicaid Web Portal Portal access requires registration and security credentials.
What a Paper Claim Must Look Like
A paper claim that doesn’t meet Florida Medicaid’s formatting standards gets rejected before anyone reviews the clinical details. The form itself must be an original, scannable CMS-1500 or UB-04 printed in red “drop-out” ink, the specific OCR-red that lets scanners read the data while ignoring the form template. Photocopies and black-ink forms are not accepted.5National Uniform Claim Committee. Do I Have to Use a Form That Is in Red Ink All data typed onto the form must be in black ink and uppercase letters.
The claim must also include:
- The billing provider’s National Provider Identifier, matching exactly what appears on the Florida Medicaid Provider Master List. A mismatch triggers an automatic rejection.
- The recipient’s Florida Medicaid identification number.
- Current ICD diagnosis codes at the highest level of specificity, along with the correct CPT or HCPCS procedure codes.6Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual Chapter 26 – Completing and Processing Form CMS-1500 Data Set
Claims with correction fluid, whiteout, or highlighted areas get rejected. To fix an error on a submitted claim, send an entirely new claim rather than altering the original.1Florida Agency for Health Care Administration. Provider Reimbursement Handbook, CMS-1500
Mail It in Time
Federal regulations require states to accept Medicaid claims submitted within 12 months of the date of service.7eCFR. 42 CFR 447.45 – Timely Claims Payment Florida’s FFS program enforces a much shorter window, generally 90 to 120 days from the date of service, and MCOs may set their own deadlines that are tighter still. A late claim is denied outright, and the provider cannot bill the patient for the unpaid amount.
For a dual-eligible patient whose claim went to Medicare first, the Medicaid filing clock typically resets. Federal rules allow up to six months after receiving the Medicare disposition notice to file the related Medicaid claim.7eCFR. 42 CFR 447.45 – Timely Claims Payment
Where Corrected Claims and Appeals Go
A corrected claim fixes a billing error on your end; an appeal disputes the payer’s decision. The two go to different places, but the mailing address for a corrected claim is the same address you used for the original. FFS corrections go back to the Tallahassee P.O. Box, and MCO corrections go back to that plan’s claims address.
Flag a correction with the right claim frequency code so the system doesn’t treat it as a duplicate:
- Frequency code 7 replaces the entire original claim. Enter 7 in Box 22 of a CMS-1500 or Box 4 of a UB-04. The replacement must include all charges, both the original line items and any additions, along with the original claim number.
- Frequency code 8 voids a previously submitted claim entirely. Same box placement, and you must reference the original claim number.
A corrected claim without the frequency code or without the original claim reference number will deny as a duplicate.
Appeals follow a separate track. For a claim denied or underpaid by an MCO, file an internal appeal with that plan within 60 days of the notice of adverse benefit determination; the MCO must confirm receipt of a written appeal within five days.8Florida Health Justice Project. How to File an Appeal with Your Medicaid Managed Care Plan If the internal appeal is unsuccessful, you can request a Medicaid Fair Hearing through AHCA by calling the Medicaid Helpline at 1-877-254-1055 or submitting a written request. For FFS claim disputes, send the resubmission with the original remittance advice, supporting documentation, and a cover letter to the same P.O. Box used for the original claim.1Florida Agency for Health Care Administration. Provider Reimbursement Handbook, CMS-1500