Does Sunshine Health require authorization?
Prior approval is required for all services by a provider who is not in the Sunshine Health network. The only exception is for emergency care. Emergency room or urgent care visits do not require prior authorization.
Is Sunshine Health a Medicaid?
Sunshine Health is a Medicaid managed care health plan that has served Florida members since 2009. Sunshine Health is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services.
What is the timely filing limit for Sunshine Health?
within 90 days
On or after Corrected claims must be submitted within 90 days from the date of service. All claim requests for reconsiderations and provider disputes must be received within 90 days from the date of original notification of payment or denial was issued.
What is Sunshine Health MMA?
Sunshine Health Managed Medical Assistance, hereafter referred to as MMA, is a managed care plan contracted with AHCA to provide Medicaid and enhanced benefits to Florida residents of all ages whose income or resources are insufficient to pay for health care.
Does Medicaid require authorization?
Medicaid is state-sponsored health coverage. When Medicaid is secondary to any other insurance plan it will NOT require authorization. MEDICARE 1.855.
Does FL Medicaid require prior authorization?
Is Staywell changing to sunshine?
On Oct. 1, 2021, our Staywell name will go away and you will become a Sunshine Health Long Term Care member. You will get a welcome letter from Sunshine Health, followed by a new Member ID card. You do not need to do anything to start enjoying the new benefits of becoming a Sunshine Health Long Term Care member.
What is the timely filing limit for simply healthcare?
90 days for participating providers and facilities. 12 months for nonparticipating providers and facilities. Timely filing is determined by subtracting the date of service from the date Simply Medicare Advantage receives the claim and comparing the number of days to the applicable federal mandate.
Which document is sent to the hospital and identifies a claim as being rejected or denied?
Explanation of Benefits (EOB) A document attached to a processed claim that explains to the provider and patient which services an insurance company will cover. EOBs may also explain what is wrong when a claim is denied.
Is Ambetter the same as sunshine health?
Sunshine Health’s plan is called Ambetter. Ambetter offers affordable health care coverage for individuals and families.
Do I need a referral to see a psychiatrist with Medicaid?
You do not need a referral to see a specialist. If you need a printed list of participating specialists, contact Member Relations at 1-800-553-0784 (TTY 1-877-454-8477).
How to apply for Sunshine health provider services?
LOAP/Practitioner Roster Form (Excel). Additions only. Please do not submit a full roster. Call Provider Services at 1-844-477-8313 or Fax 1-866-614-4955 with questions about claims, credentialing or network status As a Sunshine Health provider, you can rely on:
Where to get sunshine health home infusion form?
Home health services need to be verified by Sunshine Health. DME/home infusion form (PDF) Outptatient Therapy requests (PT, OT, ST) are managed through HN1. HN1 can be reached at 1-888-550-8800, or visit ATA of Florida.
Do you have to pay Sunshine health claims?
However, this does NOT guarantee payment. Payment of claims is dependent upon eligibility, covered benefits, provider contracts and correct coding and billing practices. For specific details, please refer to the Allwell from Sunshine provider manual.
When does the new Sunshine health payment schedule start?
As of June 1, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. Sunshine Health values our relationship with our provider partners and are pleased to announce an exciting new tool will be available April 1.