Dispute Resolution

The Florida Statewide Provider and Health Plan Claims Dispute Resolution Program IDV, administered by the Agency for Health Care Administration (AHCA), provides comprehensive dispute resolution services for health care providers and health plans. The master agreement enables independent third-party review of claims disputes, covering both contracted and non-contracted healthcare entities. Services include physician expert reviews, utilization nursing reviews, medical claims coding, and legal expert reviews, with a structured process for examining and resolving healthcare claim disagreements within 60-90 days.

The master agreement is awarded to Capitol Bridge, LLC, covering the State of Florida for a four-year contract period from January 1, 2024, to December 31, 2027. The contract is structured as a no-cost service where Capitol Bridge charges direct fees to parties involved in disputes, including an initial $87.85 filing fee and hourly rates ranging from $100 to $235 for various expert services. The contract type is a Master Agreement with annual 3% rate escalations, allowing for comprehensive claims dispute resolution across the state's healthcare ecosystem while maintaining a standardized, transparent review process.