Florida sets its prompt-pay rules in two parallel statutes, one for health insurers and one for HMOs, with matching deadlines and the same 12% interest rate. Each figure below links to the 2026 Florida Statutes or to the agency that enforces them.
To see what a late Florida payer owes on a specific claim, use the prompt pay interest calculator.
Florida prompt pay at a glance
| Statute | Fla. Stat. § 627.6131 (insurers) and § 641.3155 (HMOs) |
|---|---|
| Electronic clean claim | Pay, deny, or contest within 20 days of receipt |
| Paper clean claim | Pay, deny, or contest within 40 days of receipt |
| Late payment | 12% per year simple interest |
| Regulator for complaints | Department of Financial Services, Division of Consumer Services |
The statute
Section 627.6131 governs claim payment by health insurers, including PPO and EPO policies under subsection (15). Section 641.3155 applies the same structure to HMOs. Medicaid managed care plans are tied to the HMO statute through § 409.967(2)(j).
Chapters 2024-196 and 2025-45 added dental-only provisions on electronic payment consent and prior authorization denials. The core medical claim deadlines and the 12% rate were not changed.
Clean-claim payment deadlines
For an electronic claim, the payer must pay it or notify the provider that it is denied or contested within 20 days of receipt at its designated claims address (§ 627.6131(4); § 641.3155(3)). The claim must be paid or denied within 90 days, and a claim still unresolved at 120 days becomes an uncontestable obligation to pay. Receipt must be acknowledged within 24 hours after the start of the next business day.
Paper claims run the same steps on 40, 120, and 140 days (§ 627.6131(5); § 641.3155(4)). Receipt must be acknowledged within 15 days. When a payer contests a claim, its notice must itemize what it needs, and the provider has 35 days to send it.
Not verified: the statutes say “days” without specifying calendar or business days. We read them as calendar days.
Interest and penalties on late payment
A late claim carries interest at 12% per year, simple. Interest starts when the claim should have been paid, denied, or contested, and “is payable with the payment of the claim” (§ 627.6131(7); § 641.3155(6)).
These provisions cannot be waived by contract under § 627.6131(10). Disputes about interest alone are excluded from the state claim dispute program under § 408.7057.
Which payers the law covers
- Commercial fully insured plans: Covered, including PPO and EPO policies (§ 627.6131(15)).
- HMOs: Covered by § 641.3155 on the same timelines.
- Medicaid managed care plans: Covered. Section 409.967(2)(j) requires plan contracts to comply with § 641.3155, but complaints go to AHCA, not DFS.
- Self-funded ERISA plans: Not covered. DFS states it has no authority over self-insured ERISA plans and refers these disputes to the U.S. Department of Labor, which requires the patient or a legal representative to file.
How to file a prompt-pay complaint
The Department of Financial Services reviews alleged prompt-pay violations under §§ 627.6131 and 641.3155. Providers file through the DFS Consumer Assistance Portal linked from that page, which requires an account. Include proof that the insurer or HMO received the claims, because DFS will not proceed without it.
For a Medicaid managed care plan, work through the plan’s own complaint process first, then file with AHCA using the Medicaid complaint form or the Medicaid Helpline at 1-877-254-1055 (AHCA provider complaint page). Disputes over whether a claim is owed or how much go to the § 408.7057 dispute resolution program instead.
How prompt pay interacts with timely filing
Florida sets the provider’s filing window in the same statute: a claim must reach the primary payer within 6 months after discharge or the date of service, and that clock does not start until the provider has the patient’s correct insurer name and address (§ 627.6131(3)(b); § 641.3155(2)(b)). A secondary claim has 90 days after the primary payer’s final decision. Prompt pay starts only at receipt, so a claim filed in month five still gets the full 20 or 40 days, while one filed after month six falls outside the statutory window; our 2026 timely filing guide lists the limits for each major payer.
What we could not verify
- Day type for the 20, 40, 90, 120, and 140 day periods. The statute says “days”, and we read them as calendar days.
- Coverage of the State Group Insurance Program for state employees, which the statute text does not address.
- Whether a provider contract may set a filing deadline shorter than 6 months. The statute does not say.
- The DFS complaint form itself, which sits behind the portal sign-in.
- AHCA’s instruction that Medicaid plan late-payment complaints go to AHCA. It comes from an AHCA FAQ, and the AHCA page did not render for our final re-check.
Sources
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