Molina Healthcare of Florida Timely Filing Limit

Molina Healthcare of Florida's first published filing rule in the reviewed sources is: Medicare Advantage: one calendar year after discharge for inpatient services or after date of service for outpatient services.. Confirm the plan, provider agreement, and event that starts the filing period before submission.

At a glance

• Timely filing varies by line of business in the retrieved official materials. The Florida Medicare Advantage Provider Manual states a clean-claim timely filing limit of one calendar year after discharge for inpatient services or date of service for outpatient services. The Marketplace orientation retrieved here states that Florida Statute 641.3155 requires participating providers to submit all claims within six months of the date of service, and that corrected claims may be submitted any time during the timely filing period of the provider contract. A Medicaid-specific claim filing limit was not conclusively retrieved from the manual pages opened here.

Initial claim filing limits

• Medicare Advantage: one calendar year after discharge for inpatient services or after date of service for outpatient services.
• Marketplace: six months from date of service, as stated in Florida provider orientation materials.
• Medicaid: not conclusively retrieved from the sources opened here.

Corrected claim filing limits

• Marketplace: corrected claims may be submitted any time during the timely filing period of the provider contract.
• Medicare Advantage: corrected-claim-specific deadline not separately extracted from the retrieved pages.
• Medicaid: not conclusively retrieved from the sources opened here.

Appeal and reconsideration deadlines

• Medicare member appeal rights in the provider manual reference a written appeal filed within 60 calendar days from the date of determination for member appeals; this is not clearly a provider claim appeal deadline.
• Provider claim reconsideration/dispute deadlines were not conclusively retrieved from the pages opened here.

Trigger basis and caveats

• Medicare: timeliness is based on discharge date for inpatient services and date of service for outpatient services; if Molina is not the primary payer, the clock runs from final primary-payer determination.
• Marketplace: the orientation cites Florida statutory timely filing from the date of service.
• The source set does not provide a single unified timely-filing rule across all Molina Florida products.
• Do not assume the Marketplace six-month statutory language applies to Medicare Advantage.
• Do not assume the Medicare one-year rule applies to Marketplace or Medicaid.
• This section is conservative because corrected-claim and provider-appeal filing limits were not fully captured from all Florida product manuals.

Provider resources

• Florida Medicaid Provider Manual and Orientation (official)
• Florida Marketplace Provider Forms and Documents (official)
• Florida Medicare Advantage Provider Manual (official)
• Florida provider contact page (official)
• Florida Medicaid manual home (official)

Sources