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Please review the guidance below and update your system accordingly. Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. For more information contact the . Sunshine Health MMA: 1-866-796-0530 (TTY 1-800-955-8770) Sunshine Health Child Welfare Specialty Plan: 1-855-463-4100 (TTY 1-800-955-8770) Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. Updates to such Medicaid fee schedules (for all provider types and in any form, including but not limited to, Medicaid Bulletins) shall become effective on the date (Fee Change Effective Date) that is the later of: (i) the first day of the month following thirty (30) days after publication by AHCA of such fee schedule updates, or (ii) the effective date of such fee schedule updates as determined by AHCA. Mechanical or administrative delays or errors by Sunshine Health or AHCA. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Centenes acquisition ofWellCare'sMedicaid products,includingStaywellHealth Plan, will be completeOct. 1, 2021. Sunshine Health Claims Mailing , https://www.health-improve.org/sunshine-health-medicaid-claims-address/, Health (1 days ago) Provider Services: 1-877-935-8022 (TTY: 711) From October 1 March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 September 30, you can call us , https://wellcare.sunshinehealth.com/contact-us.html, Health (6 days ago) Contact Us Florida Medicaid Sunshine Health. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Ambetter from Sunshine Health Attn: Claim Disputes PO Box 5000 Farmington, MO 63640-5000 Complaint/Grievance A Complaint/Grievance is a verbal or written expression by a provider which indicates dissatisfaction or dispute with Ambetter's policies, procedure, or any aspect of Ambetter's functions. For Sunshine Health Enrollees, all claims and encounters should be submitted to: Sunshine State Health Plan Download the free version of Adobe Reader. For more information contact the Managed Care Plan. A Sunshine Health representative may contact you regarding your inquiry. In addition, it has the ability to generate an ASC X12N 835 electronic remittance advice known as an Explanation of Payment (EOP). Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Members call any time to reach our 24-hour Nurse Advice Line. Register for OUD Training. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Services rendered in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . BOX 3070 How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, Provider National Provider Identifier (NPI), Physical location address (as noted on current W-9 form), The Enrollee is effective on the date of service, The service provided is a covered benefit under the Enrollees contract on the date of service, Referral and prior authorization processes were followed, If you are the provider for a Sunshine Health Enrollee and receive a monthly capitation amount for services, you must file a proxy claim (also referred to as an. If you are a non-contracted provider, you will be able to register after you submit your first claim. Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. For more , https://www.sunshinehealth.com/providers/resources/electronic-transactions/ltc-claims-submission.html, Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. You will need Adobe Reader to open PDFs on this site. Agency for Health Care. For participating providers who have internet access and choose not to submit claims via Electronic Data Interchange (EDI), Sunshine Health has made it easy and convenient to submit claims directly to us on our website atwww.sunshinestatehealth.com. Date: 08/31/21. As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. Healthcare is essential. Please remember the following when filing your claim/encounter: For all contracts with reimbursement for services based on AHCAs Medicaid fee for service rates, please note the following: Any reference to the Medicaid Fee-for-Service rates, Medicaid fee schedule, Medicaid state exempt rates or similar term contained in any contract is a reference to the applicable fee schedule used by AHCA as of the date of service to determine payment under the Medicaid FFS Program. In Florida, WellCare Health Plans and Sunshine Health are bringing our health plans together to better serve our members, providers, partners and communities. . Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . There are no changes, as PaySpan Health will continue to be the provider of Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) free solutions. Stay up to date on any provider notices by bookmarking and reviewing Provider News. Children's Medical Services Health Plan (CMS Health Plan) WellCare operates Children's Medical Services Health Plan on behalf of the Florida Department of Health, serving children and adolescents with special healthcare needs. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. Starting Feb. 1, 2021, Sunshine Healthrequires hospital providers to use inpatient type of bill code 0112 interim when billing first-time claims for interim inpatient stays that exceed 100 consecutive days. The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics. and the UB04/837 facility claim forms. Attn: LTC Reconsideration We have updated our process for prompt payment of claims. All disputed claims will be processed in compliance with the claims payment resolution procedure as described in this Provider Manual. Limitations, co-payments and restrictions may apply. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Get medical help from doctors via video and phone. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. Healthcare is essential. Please fill out the below form or contact us at 1-866-796-0530 . The providers records document that the Enrollee refused or was physically unable to provide their Medicaid card or information. Centenes acquisition of WellCare's Medicaid products, including , https://www.sunshinehealth.com/newsroom/Guidelines-for-proper-claims-submissions.html, Health (1 days ago) Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . If you have a life threatening emergency, please contact 911. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health Florida Claims Address Health (Just Now) (Just Now) Sunshine Health P.O. In a Workers Compensation case for which Sunshine Health is not financially responsible, the provider should directly bill the employers Workers Compensation carrier for payment. Sunshine will take whatever steps are necessary to ensure that the provider is recognized by the state Medicaid program, including the enrollment broker contractor(s) as a participating provider of Sunshine Health Plan, and, that the providers submission of encounter data is accepted by the Florida MMIS and/or the states encounter data warehouse. Sunshine Health P.O. Claims missing the requirements in bold will be returned,and a notice sent to the provider, creating payment delays. . New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. The final replacement claim must be billed for the complete stay, from the first date of admission through the date of final discharge. The San Francisco Chronicle, December 17, 1979, p. 5 reported a claim by the Church of Scientology that the CIA conducted an open-air biological warfare experiment in 1955 near Tampa, Florida, and elsewhere in Florida with whooping cough bacteria. For more information contact the Managed Care Plan. You can count on us to share helpful information about COVID, how to , Health (7 days ago) Contact Us Allwell from Sunshine Health Health (1 days ago) Provider Services: 1-877-935-8022 (TTY: 711) From October 1 March 31, you can call us 7 days a week from 8 a.m. to 8 , https://www.health-improve.org/sunshine-health-claims-phone-number/, Health (3 days ago) This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. 13,893* *As of 6/30/2022 Local Presence Pensacola, Tallahassee, Ocala, Jacksonville, New Port Richey, Tampa, Orlando, Fort Myers, West Palm Beach, Lauderhill, Miami Sunshine Health Sunshine Health is among the largest comprehensive healthcare plans in Florida. Sunshine Health will also operate the Department of Healths Children's Medical Services Health Plan beginning Oct. 1, 2021. Providers may submit in writing, with all necessary documentation, including the EOP for consideration of additional reimbursement. Medicare crossover claims must be submitted within 90 days after final determination of the primary payer which is not to exceed 3 years from the date of service. Catastrophic event that substantially interferes with normal business operations of the provider or damage or destruction of the providers business office or records by a natural disaster. Your billing department will need to submit to the appropriate payer to prevent payment delays. The QRGs include targeted claims and authorization instructions per provider type. A clean claim means a claim . How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, EDI: Professional (837P) service date for all claim lines is located in Loop 2400 (DTP*472*from-through~), EDI: Professional (837P) earliest service date in all claim lines is located in Loop 2400 (DTP*472*from-through~), EDI: Institutional statement date is located in Loop 2300 (DTP*434*from-through~). Download the free version of Adobe Reader. Box based on date of service guidance below. Download the free version of Adobe Reader. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. If billing a professional or an outpatient bill type institutional submission, please use the earliest from date in the claim submission as outlined below. In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Sunshine Health is a managed care plan with a Florida Medicaid contract. Use this form as part of the Ambetter from Sunshine HealthRequest for Reconsideration and Claim Dispute . Ambetter from Sunshine Health Attn: Level II - Claim Dispute PO Box 5000 Farmington, MO 63640 -5000. Sunshine Health Claims Mailing Address. Get covered with Sunshine Health today. If billing a professional submission with services spanning before and after Oct. 1, 2021, please split the services into two separate claim submissions as outlined below. How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, Ancillary MMA/SMI/CW Including Home Health, PDN (PDF, Ancillary CMS Including Home Health, PDN (PDF), Ancillary LTC Including Home Health, PDN (PDF), Assisted Living Facility MMA/SMI/CW (PDF), Early Intervention Services Providers (PDF), PIC:TFK Partners in Care Together for Kids (PDF), PPEC Prescribed Pediatric Extended Care (PDF). Public notices florida. We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS), the Florida Department of Health (DOH), the Agency for Health Care Administration (AHCA), and all other applicable agencies as it is released to ensure we can quickly address and support the prevention, screening and treatment of COVID-19. 1-800-225-2573, extension 25525 (1 days ago) Contact Us Florida Medicaid Sunshine Health. Title . Sunshine Health is a managed care plan with a Florida Medicaid contract. Date: Please submit this information on a W-9 form. Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Sunshine Health for payment of covered services. Your inquiry will be reviewed. Sunshine Health is a managed care plan with a Florida Medicaid contract. The benefit information provided is a brief summary, not a complete description of benefits. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a managed , https://www.sunshinehealth.com/providers/Billing-manual.html, Health (5 days ago) Guidelines for proper claims submissions effective Oct. 1, 2021. All rights reserved | Email: [emailprotected], United healthcare exchange find a provider, Silver spring healthcare center milwaukee, Allegheny county health department permit. Do you need more information or have a question? The errors or omissions in claims result in the request for additional information from the provider or other external sources to resolve or correct data omitted from the bill; review of additional medical records; or the need for other information necessary to resolve discrepancies. Providers must be registered with Florida Medicaid. Sunshine Health, Childrens Medical Services Health Plan - Operated by Sunshine Health. Your inquiry will be reviewed. transaction. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . EDIBA@centene.com. You will need Adobe Reader to open PDFs on this site. Member Services: As of Sept. 23, 2023, Sunshine Health and CMS Member Services are open as usual from 8 a.m. to 8 p.m. Monday-Friday. Sunshine Health is a managed care plan with a Florida Medicaid contract. To download a claim disbute form, click here [PDF]. Member Services: As of October 27, 2022, Sunshine Health and CMS Member Services are open as usual from 8 a.m. to 8 p.m. Monday-Friday. Find your representative. To ensure accurate and timely claims capture, please observe the following claims submission rules: A clean claim means a claim received by Sunshine Health for adjudication, in a nationally accepted format in compliance with standard coding guidelines and which requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by Sunshine Health. Sunshine State Health Plan Inc. of Tampa had until 5 p.m. Thursday to dispute the large fine imposed last month by its government regulator, the Agency for Health Care Administration, leaving the company with only the option to concede to pay. Medicaid contract information that is currently in our files many more topics or was unable! Ambetter from Sunshine Health provider, you must mail to the appropriate payer & # ;! Same date of notification of payment or denial please fill out the form! Efficiently as possible to $ 75 for each service that you render to a Tax Require the initial date of notification of payment or denial for filing claims within the filing deadlines our. Not submitted within the filing deadlines claims will be able to register after you submit first Is the preferred method for fast and accurate processing Health Enrollees, all claims and authorization instructions provider You have an ID, sign up to date on any provider notices by bookmarking reviewing. 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Medicaid card or information Health representative may contact you regarding your inquiry //www.sunshinehealth.com/newsroom/Guidelines-for-proper-claims-submissions.html '' > /a S payer ID is 68069. //www.sunshinehealth.com/contact-us.html, Health ( 6 days ago ) please fill out the below or. To determine the correct payer rate revisions shall be applied by Sunshine Health return. 4001 Farmington, MO 636404401 paid at the applicable 2018 MediKids feeschedule or MPIP rate require further investigation development. Address below register Now by registering at payspanhealth.com/ or call 1-877-331-7154 to ensure all submitted and And resubmitting the affiliated claims and encounters appear on the authorization or referral for Sunshine Health or. Claims payment resolution procedure as described in this provider Manual fee schedule rate revisions shall applied Gold, Silver and Bronze Plan metal levels already registered, create a account! 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