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  • 1-855-838-1370
  • 4 Scammon Street, Suite 19-343, Saco, ME 04072
  • Mon to Fri 9:00AM to 06:00PM EST
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Shoreline Healthcare Technologies is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies in Florida. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Florida based practice.  Ready to outsource your billing needs?  We’ll guide you through your receivable account to make sure that your claims are paid.

Best In The Industry

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Shoreline medical billing services in Florida exceed customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

Florida Healthcare Billing Challenges we solve

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Managing Medicaid Managed Care Variability

Florida’s SMMC program requires plan-specific coding edits and prior authorizations, often leading to denials. We at Shoreline Healthcare Technologies have plan-specific rules engines that adapt claim edits based on payer. Our built-in prior authorization management reduces delays in approvals. And with proactive denial management module we track payer-specific denial patterns and suggest corrections efficiently managing your billing process to get maximum reimbursements.

Managing the Emergency Policy Waivers During Natural Disasters

The state of Florida is often affected by hurricanes that disrupt provider operations and create irregularities like missed appointments, emergency coding scenarios and disrupt billing cycles, causing delays. CMS sometimes issues temporary waivers in Florida, requiring coders to adapt quickly to disaster-specific billing rules. We at Shoreline Healthcare Technologies have adopted Cloud-based RCM systems which are accessible remotely during emergencies with automated updates regarding the CMS disaster-specific billing rules (e.g., modifier use, waived requirements). We use batch resubmission tools to quickly correct and resend claims affected by disruptions.

Higher Proportion of Out-of-State & Seasonal Residents

Florida’s “snowbird” population creates cross-state billing conflicts, particularly in Medicare Advantage and commercial insurance claims. Providers must navigate dual coding standards when patients have out-of-state insurers. Shoreline Healthcare Technologies expertise in serving across multiple states and payer networks helps providers to manage this out-of-state insurance and improves their financial stability.

High Medicare & Medicaid Fraud Scrutiny

Due to high fraud prevalence in Miami-Dade and South Florida regions providers faces more frequent audits, pre-payment reviews, and stricter billing oversight in Florida than any other states. Even a small coding errors may trigger denials or investigations. We at Shoreline Healthcare Technologies uses AI-driven claims scrubbing tools that detect mismatched CPT/ICD-10 codes before submission. We follow strict regulatory guidelines and are always audit-ready maintaining all documentation standards required by payers and regulators.

Comprehensive Medical Billing Services for Florida

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Specialized Services tailored to meet Florida’s Medicaid rules and regulations.

🩺 Services 📍 Florida Specialization 📈 Typical Improvement ⏱️ Turnaround Time
Florida Medicaid Billing Virtual Assistant for Front end management and patient communication, Real-time eligibility verification with Electronic claim submission. +35% Faster reimbursements 1-2 weeks
Billing for Medicaid Managed Care Programs Expertise in SMMC program code sets and guidelines +20% increase in revenue 24-48 Hours
Denial Management AI tools to track denial patterns and flag them Reduce denial rates by 75% 5-7 days
Credentialing Florida State licensing, Florida Medicaid provider Enrollment, ROPA Enrollment Direct payment from Medicaid and value-based incentives. 45-90 days
Patient Statements & Follow-Up Clear Explanation of EOB and Patient communication Help reduce overdue balances. 1-2 weeks

Florida Medical Billing Resources

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Comprehensive resources specifically designed for Florida Healthcare Providers to navigate the complex Billing Landscape.

Florida Medicaid Billing Guide

Complete guide to Florida Agency for Health Care Administration billing requirements and policy updates.

Statewide Medicaid Managed Care (SMMC) program Rules.

Specialized billing guidelines and code sets for SMMC programs.

Revenue Cycle Optimization

Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Florida.

Florida’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Florida

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From Miami to Pensacola, we provide comprehensive medical billing services statewide.

South Florida

Miami, Fort Lauderdale, West Palm Beach, Key West

Central Florida

Orlando, Tampa, Kissimmee, Lakeland

North Florida

Jacksonville, Tallahassee, Gainesville, St. Augustine

Panhandle Florida

Pensacola, Destin, Panama City, Fort Walton Beach

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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Common questions about medical billing services in Florida.

What is the process for checking recipient eligibility for Florida Medicaid program?

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Providers can check the recipient’s eligibility by any one of the following ways:

  • ✓ Dialling the Florida Medicaid Automated Voice Response System (AVRS) at 1-800-239-7560
  • ✓ Through Florida Medicaid web portal.
  • ✓ Submitting a 270 Health Care Eligibility Inquiry via Electronic Data Interchange (EDI).

What is the timely filing limit for Florida’s Medicaid claims?

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All Florida Medicaid claims should be filed within 12 months (365 days) from the date of service. Managed care plans have even shorter time frame (e.g., 90–180 days), so always check the specific health plan’s provider manual for filing the claims on time to avoid denials.

What is ROPA enrollment, and why is it required?

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ROPA means Referring, Ordering, Prescribing, and Attending providers. Providers must be enrolled as a ROPA provider for validating their prescriptions, lab orders, referrals, or attending role on claims. Order for labs, imaging, or pharmacy services etc will be denied if the ROPA provider is not enrolled.

What is the difference between full Medicaid enrollment and ROPA enrollment?

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With Full Enrollment providers can bill Medicaid directly for services rendered and get reimbursements.

Under ROPA Enrollment providers cannot bill Medicaid directly but they must be enrolled to appear on claims as Referring, Ordering, Prescribing, or Attending provider.

How can providers enroll as Florida Medicaid Provider?

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Providers can apply online through the Florida Medicaid Provider Enrollment Portal and submit the required documents (NPI, licenses, background screening) and pay the applicable fees. Once approved, you will be receiving the Medicaid Provider ID for billing.

What are the benefits for providers in SMMC programs?

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By participating in Florida’s Statewide Medicaid Managed Care (SMMC) program providers gets access to a larger Medicaid patient base with streamlined reimbursement and faster claim processing. It offers care coordination support, value-based incentives.

How can Shoreline Healthcare Technologies help Florida providers?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with Florida specific Medicaid rules.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billers on staff

Florida Licensed

Licensed to operate in Florida

Medical Billing Glossary

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Essential Terms for Understanding Florida’s Medical Billing Landscape

Agency for Health Care Administration (AHCA):

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The state agency of Florida for managing the Medicaid and other healthcare programs.

Florida Medicaid Management Information System (FMMIS):

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computerized system used by the agency of Florida to maintain the day-to-day functioning of the State Medicaid programs like claims processing, provider enrollment, eligibility verifications etc.

Long-Term Care (LTC):

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It is one of the Florida’s Statewide Medicaid Managed Care (SMMC) program for providing eligible individuals like seniors or disabled people services to manage their daily living activities for an extended period.

Managed Medical Assistance (MMA):

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It is also a component of the SMMC program that covers most of Florida Medicaid’s medical services like doctor visits, hospital care, prescriptions, and specialty care, delivered through managed care plans.

Statewide Medicaid Managed Care (SMMC) program:

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It is the health care services offered by the state of Florida to the Medicaid recipients. It consists of three main managed care plans the Long-Term Care (LTC) program, the Managed Medical Assistance (MMA) program, and the Dental Program.

Unified Program Integrity Contractors (UPICs):

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The private contractors hired by CMS for detecting, preventing, and investigating the fraud, waste, and abuse cases in Medicare and Medicaid claims.

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools – Shoreline has you covered! In addition to being an industry leader when it comes to pricing, we also provide personalized support for every client, With a team of experts who have worked with physicians and medical groups for years, Shoreline medical billing services in Maine understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Get your free consultation and discover how much you could save with our Maine-specialized billing services.

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Contact Information

  • 4 Scammon Street, Suite 19-343, saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • MaineCare billing specialists
  • 24-48 hour claim turnaround
  • Dedicated Maine support team