Notes on payer behavior
Florida prompt-pay law: what payers owe your practice (2026)
Florida has two prompt-pay statutes: §627.6131 for insurers and §641.3155 for HMOs. Between them they put a clock on every stage of claim handling by a Florida-regulated payer. The clocks are specific. They carry interest. And they end somewhere most people don't expect: a claim that is neither paid nor denied on time turns into an obligation the payer can no longer contest. Here's the working version.
The three clocks
- 20 days. An electronically submitted claim must be paid, denied, or contested within 20 days. (Florida's statute doesn't use "clean claim"; it defines a claim as the standard data set with all mandatory entries.)
- 90 days. The payer must pay or deny the claim within 90 days of receipt.
- 120 days. If the payer hasn't paid or denied by day 120, the claim becomes an uncontestable obligation to pay. The window to argue it is over.
Overdue claims accrue 12% simple interest, which "begins to accrue when the claim should have been paid, denied, or contested" and "is payable with the payment of the claim." On one claim the interest is small change. That isn't really the point. A demand letter that computes interest from the statutory date reads like it was written by someone who knows the statute, and payers notice that.
The supporting provisions
- Internal dispute resolution within 60 days. For contracts issued on or after October 1, 2002, the payer's internal dispute process must be finalized within 60 days of the provider's request. A dispute cannot simply sit.
- Filing floors. Payers cannot require initial filing sooner than 6 months from the date of service for outpatient claims, and a secondary claim gets 90 days from the primary payer's determination.
- The underpayment window. Providers get 12 months from the payment date to claim an underpayment, and the payer can't contract around it. That rule gets its own note: Florida's 12-month underpayment rule.
- The recoupment mirror. Payer clawbacks against physicians are capped at 12 months after payment (fraud excepted). The practice has 40 days to pay, deny, or contest a demand, a written contest must go out within 35 days, and the insurer may not offset against other claims unless the practice agrees in writing or fails to respond. The recoupment rules.
Who it covers, and who it doesn't
These are state insurance statutes, so they bind fully-insured Florida-regulated plans. Self-funded employer plans fall under federal ERISA law instead, and Medicare Advantage runs on federal rules. The card won't tell you which is which. Funding status is a per-claim check (group number or benefits documents), not something to assume. Workers' comp is a separate state regime again, with a much shorter clock; see the Florida workers' comp note.
How to use it
- Timestamp everything. The clocks run from receipt, so proof of submission is the whole game. Archive your claim-level clearinghouse acceptance reports. They start the prompt-pay clocks, and they double as timely-filing evidence later (the CO-29 note covers the proof hierarchy).
- Age open claims against the 20/90/120 marks, per payer. A claim still unadjudicated past 120 days gets a letter that cites the statute, not another status call.
- Compute the interest. Where the payer is Florida-regulated, state the 12% figure and the date it started running.
- Route underpayments to the statutory window. Short payments you find late aren't late contractual appeals. They're statutory claims with a 12-month life. Treat them that way.
None of this is specialty-specific. The same statute covers a dermatology biopsy, a screening colonoscopy, a cataract surgery, and a spinal injection. If the plan is Florida-regulated, the clocks apply. What changes by specialty is volume and dollar size, and those two things decide how much an unworked clock is costing you.