Florida Health Care Plan, Timely Filing Limit

The most important thing to confirm with Florida Health Care Plan, is not just the number of days, but also what event starts the clock. Some payer documents measure from date of service, some from discharge, and some publish different rules for corrected claims or appeals.

At a glance

• The official sources reviewed do not clearly state a universal timely filing deadline for initial claims. The provider resource guide does state that if a provider files electronic corrected claims, they should allow 15 days for electronic claims and 30 days for paper claims before resubmitting. Appeals of denied claims have separate deadlines depending on plan type and provider participation.

Initial claim filing limits

• Not clearly published in the researched sources.

Corrected claim filing limits

• Allow 15 days for electronic claims and 30 days for paper claims before resubmitting.
• Corrected claims should be clearly marked and resubmitted according to FHCP instructions.

Appeal and reconsideration deadlines

• Nonparticipating Medicare Advantage provider claim-denial appeals: submit in writing within 60 calendar days from the date of denial.
• Non-Medicare nonparticipating provider appeals: within the time limits set forth in the Certificate of Coverage when filing on behalf of the covered person.

Trigger basis and caveats

• The source language distinguishes filing/resubmission timing from appeal timing.
• Corrected-claim timing in the provider guide is framed as a wait period before resubmission, not a formal timely-filing limit.
• Because the official public sources reviewed do not give a general initial timely-filing limit, that field is left empty.
• A formal timely-filing limit may exist in contract documents, provider agreements, or line-of-business-specific manuals not publicly accessible in the reviewed sources.
• Do not assume the corrected-claim resubmission wait period is the same as the initial filing deadline.

Provider resources

• Provider Claims (official)
• FHCP Provider Resource Guide (official)
• FHCP Provider Resource Guide (alternate copy) (official)
• Resources, Education & Support (official)
• Prior Authorization Form (official)
• Prior Authorizations FAQ (official)
• Utilization Management (official)

Sources