Credentialing Services in Florida

Florida asks more of new providers than federal rules require. Every person named on a Medicaid application needs a fingerprint background screening, licensed therapists cannot enroll as solo billing providers, and each Statewide Medicaid Managed Care plan still credentials you after the state approves you. Maximum Billing is based in Fort Myers and provides credentialing services for Florida practices, covering commercial plans, Medicare, Florida Medicaid, SMMC plans, and CAQH from the first application through revalidation.

Schedule a consultation or call 800-820-0364.

Client results as of 2026. Request a billing review.

Our Florida Credentialing Services

• Choosing the right Medicaid enrollment: full, limited (managed care only), or ordering and referring.
• Background screening coordinated through the Care Provider Background Screening Clearinghouse before the application is submitted.
• Online Provider Enrollment Wizard applications, with every supporting document matched to the application.
• SMMC plan credentialing and contracts with the plans your patients use.
• Commercial plans and Medicare, including PECOS enrollment and reassignment.
• CAQH ProView built and kept current.
• Taxonomy, license, and DEA checks so every record matches.
• Revalidation tracking on Florida’s three- and five-year cycles.

Florida Medicaid: What Has to Happen First

The Agency for Health Care Administration (AHCA) runs Florida Medicaid, and Gainwell Technologies handles enrollment as its fiscal agent under AHCA’s February 2026 Provider Enrollment Policy. The fingerprint screening is the step that most often holds things up: Florida screens everyone named on the application, a broader rule than the federal one, so it needs to start before anything else. When AHCA finds something missing it sends a written notice, and there are 21 days to fix it before the application is denied. Our Florida Medicaid provider enrollment guide explains the Wizard and the documents.

SMMC Plans After State Approval

Joining a Statewide Medicaid Managed Care network requires Florida Medicaid enrollment, and the plans are required to enroll the providers they contract with within 60 days. Each plan is still its own contract. Plans on the state’s managed care choice site include:

• Aetna Better Health of Florida, Simply, Humana, Molina, Sunshine Health, and UnitedHealthcare
• Children’s Medical Services Health Plan, Community Care Plan, and Florida Community Care
• Dental plans DentaQuest and Liberty Dental

Credentialing Florida Therapists and Behavioral Health Groups

A Florida LCSW, LMHC, LMFT, or psychologist enrolls in Medicaid under Specialized Therapeutic Services as a group or a group member, never as an individual biller; a sole proprietor enrolls as a member of their own group. Full enrollment needs a link to a Community Behavioral Health Services group, while limited enrollment for managed care networks does not. Getting this structure wrong is one of the most common reasons a therapist’s application stalls. See our mental and behavioral health credentialing services and Florida mental health billing services.

Dentists and Physician Groups

Florida requires dental groups to be owned by dentists, and physician groups mostly owned by non-physicians must post a surety bond. For dental practices, credentialing also covers the SMMC dental plans and commercial dental networks. See our dental credentialing services and Florida dental billing services.

Revalidation Cycles

Under the February 2026 policy, most individual clinicians revalidate every five years. Institutional, ordering and referring, durable medical equipment, crossover-only, and out-of-state providers revalidate every three years. Some older AHCA pages still describe a single five-year cycle, so the notice you receive is the date to follow. We track these alongside commercial re-credentialing and CAQH re-attestation.

How Long It Takes

AHCA says enrollment takes 60 days or less once an application is complete. SMMC plan credentialing comes after that, so a new clinician should start the process several months before the first Medicaid managed care patient.

Frequently Asked Questions

Can a Florida therapist enroll in Medicaid as an individual?

No. Therapists enroll under Specialized Therapeutic Services as a group or as a group member, including sole proprietors.

Who needs fingerprinting for Florida Medicaid?

Everyone named on the application, through the Care Provider Background Screening Clearinghouse.

How long does Florida Medicaid enrollment take?

AHCA states 60 days or less once the application is complete. Plan credentialing follows.

Is Maximum Billing located in Florida?

Yes. We are based in Fort Myers and credential practices across the state.

Credentialing for Florida Practices

Tell us about your clinicians, your group structure, and the plans you want to join, and we will put the steps in order. We also handle Florida medical billing once you are in network. See our credentialing and payer enrollment services, or contact us to get started.