Calculating Claims, Made Easy

Does your practice struggle with low reimbursement due to denied and underpaid claims? Use this tool to determine whether insurers denying your claims are in compliance with Florida rules and regulations.

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Gain control over your problem receivables

Does your practice struggle with low reimbursement due to denied and underpaid claims?

Medical Insurance Claim Form

Collect outstanding accounts receivable from insurers for unpaid and underpaid claims by following Florida’s applicable statutes for prompt payment and proper reimbursement levels. Ask us how to enact a plan for your practice to improve your revenue stream.

Make sure your practice is collecting 100% of the amounts owed by insurers by using the tools enclosed. Please contact our office with any questions about noncompliant insurers and remedies that we can use to enforce physicians’ rights.

Tools & Calculators

To begin, click on any of the tabs to use any of our calculators.

Interest

How to calculate Interest

  • Providers are entitled to collect 12% interest on any amounts owed by insurers for overdue or underpaid claims.

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Prompt Payments

How to calculate Florida's Prompt Payment deadline

  • Failure to pay or deny a claim w/n 120 days of the date of submission of the electronic claim creates an uncontestable obligation to pay.

  • Failure to pay or deny a claim w/n 140 days of the date of submission of the non-electronic/paper claim creates an uncontestable obligation to pay.


To begin please enter a Submission Date and a Claim Type.

Recoupment/Take Back Request

How to calculate Recoupment/Overpayment Deadlines

  • Insurer’s recoupment requests for underpayment must be submitted to Florida licensed physicians within 12 months after the date of payment of the claim.

  • Provider must submit a written response to the overpayment request within 35 days of receipt of the recoupment request.

  • Insurer may not set off the amounts sought unless the provider agrees to the reduction in writing or fails to respond to the overpayment request.

To begin please enter a Payment Date.

Timely Filing to Primary

How to calculate Timely Filing Deadlines

  • The initial claim must be submitted to the patient's primary insurance within 6 months of the date of service.

  • Insurer has 20 days from receipt of claim to pay claim or request additional information from the provider.

  • Provider has 35 days from the date the notice for more information from insurer was mailed to provide the requested information.

To begin please enter a Date of Service.

Timely Filing to Secondary

How to calculate the Timely Filing Deadline for submitting a claim to the patient's Secondary Insurance

  • Secondary claims must be submitted within 90 days of the date of the primary insurer's explanation of benefits.

  • Insurer has 20 days from receipt of claim to pay claim or request additional information from the provider.

  • Provider has 35 days from the date the notice for more information from insurer was mailed to provide the requested information.

To begin please enter the primary insurance EOB date.