Medicaid Billing & Reconciliation
RFI §5 Demonstration Requirements · Billing & reconciliation capabilities, if applicable
This module is optional for Healthy Start. Shown here because our Flex platform is already processing Medicaid submissions today via Netsmart EVV in Georgia. The same pipeline applies if Florida chooses to bill Medicaid for Healthy Start service encounters.
Billable encounters QTD
12,482
↑ 8% vs last quarter
Submitted to MMIS
11,908
95.4% submission rate
Paid / Acknowledged
10,724
90.1% of submitted
Pending reconciliation
418
Avg age 11 days
Denied — needs work
148
1.2% denial rate
Billable encounters queueSample · 10 of 12,482
| Date | Participant | Coalition | Service | Code | Units | Amount | Status |
|---|---|---|---|---|---|---|---|
| Apr 22 | Yanelis Fuentes | Palm Beach | Prenatal intake | T1028 | 1 | $64.00 | Billable |
| Apr 22 | Destiny Brown | Palm Beach | Nutrition counseling | S9470 | 1 | $48.00 | Billable |
| Apr 21 | Keisha Williams | Palm Beach | Home visit prenatal | T1016 | 1 | $72.00 | Submitted |
| Apr 21 | Ashley Santiago | Palm Beach | EPDS screening | 96127 | 1 | $21.00 | Submitted |
| Apr 20 | Marisol Cabrera | Palm Beach | Targeted case mgmt | T1017 | 4 | $96.00 | Paid |
| Apr 19 | Tiffany Watts | Broward | Postpartum home visit | T1016 | 1 | $72.00 | Paid |
| Apr 18 | Brianna Cole | NE Florida | Risk screen | H0031 | 1 | $35.00 | Hold · eligibility |
| Apr 17 | Shantel Davis | Palm Beach | Infant follow-up call | 98966 | 1 | $18.00 | Paid |
| Apr 17 | Deja Holloway | Orange / Seminole | Home visit prenatal | T1016 | 1 | $72.00 | Denied · code |
| Apr 16 | Alexis Park | Tampa Bay | Childbirth ed | S9442 | 1 | $38.00 | Paid |
Submissions & collections
90% first-pass acceptance rate — up 4 points YoY.
Reconciliation queueERA / 835 import
Batch FL-HSF-2026-Q3-APR-17 reconciled
842 claims · 100% match to 835 remit · MCD-FL-042026-A
$54,218.00
Paid 100%
Batch FL-HSF-2026-Q3-APR-18 partial match
714 claims · 688 match, 26 short-paid · MCD-FL-042026-B
$46,104.00
Paid $44,890
− $1,214 variance
Batch FL-HSF-2026-Q3-APR-19 missing remit
428 claims · ERA expected, not received · > 10 days
$28,492.00
No remit received
Batch FL-HSF-2026-Q3-APR-15 reconciled
1,104 claims · 100% match · MCD-FL-042026-C
$72,104.00
Paid 100%
Batch FL-HSF-2026-Q3-APR-14 partial
618 claims · 7 denied (eligibility) · MCD-FL-042026-D
$39,816.00
Paid $39,264
− $552 variance
Eligibility verification (270 / 271)Real-time
YF
Yanelis Fuentes · MCD-****4721
Checked today 8:04 AM · Pregnancy Medicaid active
DB
Destiny Brown · MCD-****8920
Checked today · Straight Medicaid active, WIC enrolled
DW
Destiny Washington · MCD-****0311
Checked 3x since 4/15 · plan not found · flagged
BC
Brianna Cole · MCD-****7185
Retroactive termination · last active 3/31
AS
Ashley Santiago · MCD-****3108
Postpartum extension · valid through 9/12/26
MC
Marisol Cabrera · MCD-****5094
Managed care plan: Sunshine Health
Denial reasons — last 30 days
Payer mix & MCO breakdown
Billing pipeline shares the submission + reconciliation infrastructure we run today for Netsmart EVV in Georgia.
See Netsmart integration →
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