Statewide Provider and Health Plan Claim Dispute Resolution Program

The Agency for Health Care Administration is contracted with MAXIMUS, an independent dispute resolution organization, to provide assistance to health care providers and health plans in order to resolve claim disputes. MAXIMUS has been accepting claim disputes for Florida’s managed care line of business since May 1, 2001. 

Services offered by Maximus are available to Medicaid managed care providers and health plans.  Claims submitted to managed care plans that have been denied in full or in part, or allegedly underpaid or overpaid may be eligible for dispute under the arbitration process.

To learn more about this program, access the “Frequently Asked Questions”.

Application forms and instructions on how to file claims disputes can be obtained directly from MAXIMUS by calling 1-866-763-6395 (select 1 for English or 2 for Spanish), and then select Option 5 - Ask for Florida Provider Appeals Process.