Reimbursement Disputes

Reimbursement Disputes are handled by the Division's Medical Services Section located within the Bureau of Monitoring & Audit. Subsection 440.13(7), Florida Statutes and Chapter 69L-31, Florida Administrative Code, outline the reimbursement dispute resolution process. Listed below are high level bullets for parties of a reimbursement dispute and several links to participate or learn more about this process.

Health care providers electing to contest the disallowance or adjustment of payment by a carrier:

  • Must petition the Division to resolve the dispute within 60 days after receipt of notice of disallowance or adjustment of payment.
  • The petitioner must serve, by United States Postal Service certified mail or by a common carrier with verifiable tracking methods, a copy of the petition on the carrier and on all affected parties listed on the notice of disallowance or adjustment.
  • The petition must be accompanied by all documents and records that support the allegations contained in the petition. Failure of a petitioner to submit such documentation to the department may result in dismissal of the petition.

Carriers responding to reimbursement dispute petitions:

  • Must submit to the Division within 45 days after receipt of the petition all documentation substantiating the carrier's disallowance or adjustment of payment.
  • Failure of the carrier to timely submit such documentation to the Division within 45 days constitutes a waiver of all objections.