THE BILL ITSELF
CS/SB 1082
Statewide Provider and Health Plan Claim Dispute Resolution Program
Florida Senate - 2026 CS for SB 1082 By the Committee on Health Policy; and Senators Grall and Gaetz 588-02227-26 20261082c1
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A bill to be entitled
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An act relating to the statewide provider and health
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plan claim dispute resolution program; amending s.
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408.7057, F.S.; specifying additional circumstances
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under which a disputed claim is not subject to review
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under the statewide provider and health plan claim
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dispute resolution program; providing an effective
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date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Paragraph (b) of subsection (2) of section
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408.7057, Florida Statutes, is amended to read:
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408.7057 Statewide provider and health plan claim dispute
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resolution program.—
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(2)
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(b) The resolution organization shall review claim disputes
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filed by contracted and noncontracted providers and health plans
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unless the disputed claim:
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1. Is related to interest payment;
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2. Does not meet the jurisdictional amounts or the methods
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of aggregation established by agency rule, as provided in
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paragraph (a);
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3. Is part of an internal grievance in a Medicare managed
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care organization or a reconsideration appeal through the
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Medicare appeals process;
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4. Is related to a health plan that is not regulated by the
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state;
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5. Is part of a Medicaid fair hearing pursued under 42
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C.F.R. ss. 431.220 et seq.;
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6. Is the basis for an action pending in state or federal
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court; or
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7. Is subject to a binding claim-dispute-resolution process
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provided by contract entered into prior to October 1, 2000,
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between the provider and the managed care organization ;
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8. Is related to services initiated pursuant to s. 395.1041
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or 42 U.S.C. s. 1395dd and has been submitted and meets the
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criteria for resolution through the federal independent dispute
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resolution process; or
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9. Is related to services rendered by out-of-network
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providers and has been submitted and meets the criteria for
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resolution through the federal independent dispute resolution
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process .
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Section 2. This act shall take effect July 1, 2026.