State Guide

Credentialing in Florida

Enrollment guides for 58 payers operating in Florida.

What actually differs in Florida

Credentialing advice written for "most states" tends to be wrong here in specific, expensive ways. These are the rules that only apply in Florida.

6 sourced rules, each linked to its source

Getting enrolled 1 Who on your team can bill 1 Licensing and prescribing 4

6 sourced rules

Every claim on this page links to the statute, rule or agency page it came from. Last checked July 2026.

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Medicaid sanctioned-provider screening Fla. Stat. § 409.913(37)

Florida's statutory Medicaid exclusion list (s. 409.913(37), F.S., updated at least monthly) has no flat-file download. It is only searchable through AHCA's dm_web public-records application. Of roughly 7,100 rows, only TERMINATION and SUSPENSION entries are exclusions; FINE/CAP rows are monetary sanctions on still-enrolled providers, so screening against the full list floods reviewers with false flags.

AHCA dm_web Medicaid Sanctioned Providers portal via kb/states/fl.md · checked Jul 2026

Pre-licensed behavioral health billing Rule 59G-4.052, F.A.C.

Florida Medicaid never enrolls registered interns (RMHCI/RCSWI/RMFTI) individually: they render only inside enrolled community behavioral health agencies as master's-level practitioners, and the agency bills. Per the Behavioral Health Therapy Services Coverage Policy (Rule 59G-4.052, F.A.C.), all providers delivering BH therapy services must be employed by or contracted with a community behavioral health agency, and only licensed practitioners direct treatment.

FL Medicaid Behavioral Health Therapy Services Coverage Policy via kb/states/fl.md · checked Jul 2026

Nurse practitioner practice authority

Florida NPs practice under a physician protocol by default (restricted authority), with an Autonomous APRN registration available for primary care and CNM practice: 3,000 supervised hours in the past 5 years plus graduate coursework in differential diagnosis and pharmacology.

Florida DOH MQA licensing research via kb/states/fl.md · checked Jul 2026

Out-of-state telehealth registration Fla. Stat. § 456.47

Florida's telehealth registration (s. 456.47, F.S.) lets out-of-state practitioners treat Florida patients remotely without a full FL license, it is free and never expires. Requirements: an unencumbered home-state license, a Florida registered agent, and malpractice coverage that covers telehealth; no in-person Florida services are permitted. Registration is not payer enrollment, Florida panels still require their own applications.

Florida DOH MQA portal (flhealthsource.gov) via kb/states/fl.md · checked Jul 2026

Professional licensing and verification

All health professions apply and verify through flhealthsource.gov, the Department of Health MQA portal, with a 30-day statutory review of initial applications. Physician licenses renew biennially. MD endorsement runs $700 plus the NICA assessment ($0/$250 per year, $5,000 for OBs, an easy miss in cost planning); LMHC/LCSW/LMFT endorsement is $180.

Florida DOH MQA portal (flhealthsource.gov) via kb/states/fl.md · checked Jul 2026

State controlled-substance registration

Florida issues no separate state controlled-substance registration. DEA registration alone governs prescribing. Prescribers do owe a 2-hour controlled-substance CE at each renewal.

Florida DOH MQA licensing research via kb/states/fl.md (verified by absence) · checked Jul 2026

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A credentialing manager files the applications, chases the payers and tracks your recredentialing dates.

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Who Runs Florida Medicaid Provider Enrollment

50-state research

Enrollment Portal

Florida MMIS provider portal

Operated By

Gainwell Technologies

Platform

FMMIS

Gainwell holds the Florida fiscal agent contract through December 2027.

Go to the official Florida enrollment portal

From PayerReady's 50-state Medicaid enrollment platform research, verified July 2026. Portal contracts change; where an operator is in transition or not publicly confirmed, we say so rather than guess.

Aetna

Aetna (CVS Health)

Commercial

Network: Open

Timeline: 90-150 days

CAQH Required

Credentialing in Florida

What actually differs in Florida

Who Runs Florida Medicaid Provider Enrollment

Aetna

UnitedHealthcare

Cigna Healthcare

Anthem / Elevance Health

Humana

Centene Corporation

Molina Healthcare

Florida Blue

Florida Medicaid

UnitedHealthcare Community Plan

Aetna Better Health

Molina Healthcare (Medicaid)

WellCare (Centene)

AmeriHealth Caritas

TRICARE

TRICARE East Region (Humana Military)

CHAMPVA

Delta Dental

Cigna Dental

MetLife Dental

Guardian Dental

Aetna Dental

United Concordia

DentaQuest

MCNA Dental

Liberty Dental Plan

Dental Network of America

VSP Vision Care

EyeMed Vision Care

Davis Vision

Spectera / UHC Vision

Optum Behavioral Health

Carelon Behavioral Health

Magellan Health

Evernorth Behavioral Health

Oscar Health

Devoted Health

Bright Health

Workers' Compensation

First Coast Service Options (Jurisdiction N)

CGS Administrators (DME B/C)

Amerigroup (Anthem)

Ambetter

AmeriHealth Caritas

Amerigroup (Wellpoint)

Anthem Blue Shield

Blue Cross Blue Shield

Carelon

Centene Corporation

Community Plan

Compsych

Medicaid

Medicare

Medicare Fee-for-Service (CMS)

Megellan

MultiPlan

Oscar

WellCare

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