The Florida Medicaid claims address depends on how the recipient is enrolled. Most Florida Medicaid recipients belong to a managed care plan under the Statewide Medicaid Managed Care program, and their claims go to the plan listed on the member’s ID card, not to the state. For the smaller Fee-for-Service population, paper professional claims go to Florida Medicaid, P.O. Box 14597, Tallahassee, FL 32314-4597, processed by Gainwell Technologies as the state’s fiscal agent. Institutional claims on the UB-04 use a separate P.O. Box. Sending a claim to the wrong destination is one of the quickest ways to trigger a rejection.
Fee-for-Service Paper Claims
Gainwell Technologies LLC processes fee-for-service claims on behalf of the Agency for Health Care Administration (AHCA). The CMS-1500 Provider Reimbursement Handbook directs professional paper claims to:
Florida Medicaid
P.O. Box 14597
Tallahassee, FL 32314-4597
Professional claims on the CMS-1500 cover 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 and go to a separate P.O. Box designated in the UB-04 Provider Reimbursement Handbook. 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
AHCA updates these addresses periodically. Confirm the current mailing destination in the applicable reimbursement handbook before you drop a paper claim in the mail.
Managed Care Organization Claims
The majority of Florida Medicaid recipients are enrolled in a managed care 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 these members, claims go directly to the MCO. Not to Gainwell, and not to AHCA.
Each MCO runs its own claims processing operation, and the mailing address is typically printed on the member’s ID card and published in the plan’s provider manual. 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 also splits behavioral health claims by 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 in their provider manuals. Verify the member’s plan enrollment first, then pull the address from that plan’s manual or the member’s ID card. A managed care claim sent to the FFS fiscal agent will be returned or denied.
Electronic Claims Submission
Electronic submission is the expected method for the overwhelming majority of Florida Medicaid claims. Two pathways handle most volume: EDI through a clearinghouse, and direct entry through the state portal.
Clearinghouse Payer IDs
For Florida Medicaid FFS claims submitted through a clearinghouse, the payer ID is 77027 for both professional (837P) and institutional (837I) transactions, and for electronic remittance advice (835). For eligibility verification (270/271) and claim status inquiries (276/277), the payer ID is FLMCD. MCO claims use each plan’s own electronic payer ID, which the clearinghouse directory or the MCO’s provider manual will list.
The Florida Medicaid Web Portal
AHCA operates the Florida Medicaid Secure Web Portal at home.flmmis.com. Enrolled providers can submit claims directly, verify eligibility, retrieve remittance advices, and update provider records.4Florida Agency for Health Care Administration. Florida Medicaid Web Portal Access requires registration and appropriate security credentials.
Corrected Claims and Resubmissions
When a claim was processed but paid incorrectly because of a billing error on your end, submit a corrected claim rather than an appeal. Corrected claims go to the same address as the original: the FFS P.O. Box for fee-for-service claims, or the MCO’s claims address for managed care members.
Flag the submission with a claim frequency code so the system doesn’t treat it as a duplicate:
- Frequency code 7 (Replacement) replaces the entire original claim. On a CMS-1500, enter code 7 in Box 22. On a UB-04, it goes in Box 4. The replacement must include all charges, both the original line items and any additions, along with the original claim number.
- Frequency code 8 (Void) cancels a previously submitted claim entirely. Same placement, Box 22 on a CMS-1500 or Box 4 on a UB-04, with a reference to the original claim number.
A corrected claim submitted without a frequency code or without the original claim reference will be rejected as a duplicate.
Timely Filing
The address only helps if the claim arrives in time. Federal regulations require states to accept Medicaid claims filed within 12 months of the date of service.5eCFR. 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 individual MCOs can set their own deadlines that run tighter still. A late claim is denied outright, and the provider cannot bill the patient for the balance.
For a dual-eligible beneficiary whose claim went to Medicare first, the Medicaid clock generally resets. Federal rules allow up to six months after the Medicare disposition notice to file the related Medicaid claim.5eCFR. 42 CFR 447.45 – Timely Claims Payment
Before You Send
A quick check before any paper claim goes out: confirm the member’s plan enrollment, pull the address from that plan’s provider manual or ID card if it is managed care, or use the current FFS handbook address if it is fee-for-service. Match the form to the address, CMS-1500 to the professional P.O. Box, UB-04 to the institutional one. And keep the claim inside the tighter of the two filing windows that apply, the state’s or the MCO’s. Everything else about the claim can be right, and the wrong envelope will still cost you weeks.