Florida Medicaid Providers – How to File a Complaint

If the issue involves a Medicaid Managed Care Plan, you should use the plan’s provider complaint process prior to submitting a complaint to the Agency.  All plans have a provider complaint system to allow providers to dispute plan policies, procedures, or any aspect of a plan’s administrative functions, including proposed actions, claims/billing disputes, and service authorizations.  Plans must maintain a complete and accurate record of all complaints and share this information with Agency. Plan contact information is available online at Plan Complaint Contacts for Providers.

If your issue does not involve a plan or you are unsuccessful in addressing your issue with the plan, you can submit a complaint to the Agency using one of the options below.

  1. To submit a complaint online you may use the Florida Medicaid Complaint Form. Please refer to the NEW Provider Complaint Tip Sheet for helpful hints on submitting your complaint.
  2. To submit a complaint by phone, please call the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970). Staff are available to assist you Monday through Friday, 8am-5pm EST.
When submitting your complaint online, you also have the option of attaching any related documents. Please remember that submitting attachments containing patient information about non-Medicaid members is a HIPAA violation. Additionally, attachments that include enrollee information for multiple plans on the same document cannot be accepted.

Already submitted a complaint? Find your Complaint Status here.

Providers now have the ability to save a Complaint Profile, which can be used when submitting a complaint online.  This will reduce the data entry required for any future complaint submissions made from the same device and browser.  Instructions for this are in the Complaint Profile User Guide.