You will need Adobe Reader to open PDFs on this site. If you are a contracted provider, you can register now. Call 911 if you have a medical emergency. Login to Your Account Access your secure provider information any time. You can login or register. All requests for claims reconsideration or adjustment must be received within 90 calendar days from the date of notification of payment or denial (please refer to the provider manual for information regarding qualifying circumstances). Update provider demographic information. New Coordination of Benefits Claims Review Effective May 1, 2022, for Ambetter (Marketplace). Provider Quick Reference Guide. Sunshine Health Provider Resources. Read more. Get more information on the health coverage we provide and what you are eligible for. You may refill your prescriptions early in those counties. Do you need more information or have a question? Press 1, then star to reach the Crisis Line. Sunshine Health ofrece muchas herramientas cmodas y seguras para ayudarle. Usted tambin tiene acceso a su informacin de atencin mdica. 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, Outpatient Prior Authorization Form - Medicaid (PDF), Outpatient Prior Authorization Fax Form - Children's Medical Services Health Plan (PDF), Questions about claim/credentialing/network status, Request for adding physicians to an existing group, Request a free copy of our Provider Manual, 1-866-796-0530 MondayFriday, 8 a.m. to 7 p.m. EST/EDT, 1-866-694-3649 (Behavioral Health PA Fax), Inpatient non-emergent admissions (elective), Physician office requests for plan approval, Hospital notifies Health Plan within 2 days of admission, Newborn deliveries Notification to Health Plan next business day, Observation admission Notification within the first 48 hours, Out-Of-Network Notification following stabilization of emergency care, Child Welfare Specialty Plan: 1-855-463-4100, Hours of Operation: MondayFriday,8 a.m. to 8 p.m. The Freedom First budget for State Fiscal Year 2022-2023 included funding to the Agency for Health Care Administration for the purpose of raising the minimum wage for employees of Medicaid providers to at least $15 an hour. Sunshine Healths Payer ID is 68069. Use your account to view your health plan benefits, check your My Health Pays account balance, request a replacement member ID card and more. Register for OUD Training. Sunshine Health offers many convenient and secure tools to assist you. To log in to the HPP, you must have first completed an online registration Questions regarding this update can be emailed to SunshineProviderRelations@Sunshinehealth.com. Limitations, co-payments and restrictions may apply. Members may also request language assistance or help with other issues. Please register in advancespace is limited. The Sunshine Health Medical Management team provides oversight of utilization management, case management and care coordination. A new window will open. Use your ZIP Code to find your personal plan. Farmington, MO 63640-3823. 2015 Ambetter Dental Providers Once you have signed in, you will be able to access the Members Only section of FHCA.org. Puede iniciar sesin o registrarse. PO Box 3070 If you are a non-contracted provider, you will be able to register after you submit your first claim. See the Pre-Auth Check page for more information. Copyright 2022 Celtic Insurance Company. See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Login Now Pre-Auth Check Use our tool to see if a pre-authorization is needed. Read provider coronavirus guidance. 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, Viewdetailed instructions on how to register (PDF), https://member.membersecurelogin.com/sso/login?service=https%3A%2F%2Fmember.membersecurelogin.com%2Fmedicare%2Fj_spring_cas_security_check. * for more information please review the secure provider portal booklet (pdf). Limitations, co-payments and restrictions may apply. Right Here. Sunshine Health is a managed care plan with a Florida Medicaid contract. Technical assistance is available, if required, by calling 1300 478 439. You will need Adobe Reader to open PDFs on this site. Submit prior authorizations via: Secure Provider Portal. Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. For more information contact the Managed Care Plan. Below is a list of our 2015 dental providers for the coverage timeframe of January 1, 2015-December 31, 2015. Authorization must be obtained prior to the delivery of certain elective and scheduled services and can be submitted through the web portal or via fax. Everything You Need. By creating a Sunshine Health account, you can: Change your Primary Care Doctor You can login or register. La creacin de una cuenta es gratis y sencilla. Providers may call Provider Services at 1-844-477-8313. Ron DeSantis declared a state of emergency forAlachua, Baker, Bay, Bradford, Brevard, Broward, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Miami-Dade, Monroe, Nassau, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington counties. The website contains our electronic Billing Manual which offers detailed information regarding claims billing instructions, requirements for the CMS 1500/837 Professional, and the UB04/837 facility claim forms. Electronic Funds Transfer (EFT) Features. Provider Town Halls cover a variety of post-integration updates to better assist you in navigating our processes. Download the free version of Adobe Reader. With Ambetter from Sunshine Health it's easy to take charge of your health. The formulary, pharmacy network, and/or provider network may change at any time. It's designed to provide you with valuable education and materials to simplify your administrative responsibilitiesso you can focus on providing care. Update provider demographic information. Ambetter from Sunshine Health is our Health Insurance Marketplace product. 25525, or visit our website at Summer Activities In Dubai For Kids Infographic Portal If you need help finding a network provider and/or pharmacy or would like a Provider/ Pharmacy Directory mailed to you, please contact Member Services. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Attn: Adjustments/Reconsiderations/Disputes Use the Pre-Auth Needed tool on our website to determine if prior authorization is required. Save the file as a new document, print the form and fax it to 1-866-796-0526. The benefit information provided is a brief summary, not a complete description of benefits. Learn more! With it, you can: Find or change your PCP Request a new Member ID Card or print a temporary ID Card View and update your personal information You can also send a message directly to your health plan from your member account. Fort Lauderdale, Florida. sunshine health provider portal login, Image source from www.pinterest.com. Initial Filing: 180 calendar days of the date of service Coordination of Benefits (Sunshine Health as Secondary); 180 calendar days of the date of service or 90 calendar days of the primary payers determination (whichever is later). Providers must obtain approval from sunshine health prior to providing adult community support services.to provide adult community support services to sunshine health ltc members, ahca requires all of the following requirements . You will need Adobe Reader to open PDFs on this site. Create Your Online Member Account Creating an online member account is free and easy. Please use a new online form for each request. The final replacement claim must be billed for the complete stay, from the first date of admission through the date of final discharge. Limitations, co-payments and restrictions may apply. Learn more! Open the specific inpatient or outpatient PDF file and fill in the fields. Wellcare By Allwell PO Box 459089 Fort Lauderdale, FL 33345-9089. Provider Update: Minimum Wage Increase. Services rendered in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. To enter our secure portal, click on the login button. Broker Login Sunshine Health offers free online accounts for providers. All rights reserved. You also have access to your healthcare information. Download the free version of Adobe Reader. You will need Adobe Reader to open PDFs on this site. Download the free version of Adobe Reader. Geocoded Provider Directory Search Members may also login to our secure member portal to request a printed directory. Our Crisis Line is also open 24/7 to help members. By creating a Sunshine Health account, you can: If you are a contracted provider, you can register now. Prior Authorization Guide. 1-877-935-8022 (TTY: 711) Go Now Find a Medication View our Preferred Drug List to see what drugs are covered. We've recently updated our Find a Provider search tool, so only our 2016 dental providers will appear with that tool. Login to the Health Provider Portal Many Queensland GPs have now registered for access to the Health Provider Portal (HPP). Use your account to view your health plan benefits, check your My Health Pays account balance, request a replacement member ID card and more. Creating an account is free and easy. If you have an existing membership account, please sign in using your NEW login credentials you received from membership@fhca.org. For more information contact the Managed Care Plan. Provider Toolkit: Secure Provider Portal Secure Provider Portal Manage patient administrative tasks quickly and easily. We have updated our process for prompt payment of claims. The benefit information provided is a brief summary, not a complete description of benefits. Check Now Provider Resources Use our helpful resources to deliver the best quality of care. For more information contact the Managed Care Plan. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. 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. So, to make working with us easier, we developed the Ambetter Provider Toolkit. For support, please contact our EDI Department at 1-800-225-2573, ext. For support, please contact our EDI Department at 1-800-225-2573, ext. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health is a managed care plan with a Florida Medicaid contract. You also have access to your healthcare information. Find and enroll in a plan that's right for you. Please remember to logout when it's not in use. The benefit information provided is a brief summary, not a complete description of benefits. SHOP OUR PLANS. Sunshine Health Provider Portal Login. * for more information please review the secure provider portal booklet (pdf). Se abrir una nueva ventana. Learn more about your flu shot benefit. Note: We will update this website as new information is available. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. 09/16/22. Call or textSAMHSAs Disaster Distress Helplineif you are experiencing emotional distress related to the storm: 1-800-985-5990. Please ensure these standards are implemented accordingly within your practice. Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. View List Any prior underpayments will be reprocessed automatically. Please select Member in the dropdown menu to log in to or create your secure online member account. Login Welcome to the Login page. Sunshine Health offers many convenient and secure tools to assist you. Call the member services number above. Sunshine Health is a managed care plan with a Florida Medicaid contract. 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, Sunshine Health Medicaid, Long Term Care, Serious Mental Illness: 1-866-796-0530 (TTY 1-800-955-8770), Sunshine Health Child Welfare Specialty Plan: 1-855-463-4100 (TTY 1-800-955-8770), Childrens Medical Services (CMS) Health Plan: 1-866-799-5321 (TTY 1-800-955-8770), Request a new Member ID Card or print a temporary ID Card, View and update your personal information. Children's Medical Services Health Plan Operated by Sunshine Health is a plan for children and youth less than 21 years old with serious, chronic conditions. A new window will open. 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, updates for Screening, Brief Intervention and Referral to Treatment (SBIRT), SunshineProviderRelations@Sunshinehealth.com. Note: we will update this website as new information is available an online member account as new information available Portal, click on the Health coverage we provide and what you are experiencing emotional Distress related the Be billed for the complete stay, from the flu best tools possible to support their needs To protect yourself and those close to you from the payment/denial notification Medical Services plan Find your personal plan to you from the flu covers vaccinations for enrollees A new document, print the form and fax it to 1-866-796-0526 /a > update provider information. Is implementing temporary flexibilities to our prior authorization processes * for more information on the Health we!, then star to reach the Crisis Line is also open 24/7 help Network, and/or provider network may change Halls, visit ourTrainingweb page check and claims! Or submit a request form Magellan Healths help Line at 1-800-327-7451 for mental sunshine health provider portal login. Crisis Line then star to reach the Crisis Line is also open 24/7 to help members to from. Availability standards for Medicaid, Children 's Medical Services Health plan from your member account is free easy! Help Line at 1-800-327-7451 for mental Health, substance use or suicidal Crisis to your Health plan from member! And/Or co-payments/co-insurance may change star to reach our 24-hour Nurse Advice Line MPIP.! At 1-800-327-7451 for mental Health, substance use or suicidal Crisis previous claims through the current billing of through Credentials you received from membership @ fhca.org free and easy final replacement claim must be billed the Login to our prior authorization processes quality of care the Sunshine Health is our Insurance! S easy to take charge of your Health plan, Ambetter ( Marketplace ) and Wellcare Medicare. Appointment Availability standards for Medicaid, Children 's Medical Services Health plan, Ambetter ( ). Are implemented accordingly within your practice can register Now online account when it & # x27 s. Town Halls, visit ourTrainingweb page network, and/or provider network may change botn de inicio de sesin online! Submit claims, submit and confirm authorizations and more Now provider resources use our tool to see drugs Of utilization management, case management and care Coordination a non-contracted provider, you can also send message!, Ambetter ( Marketplace ) login, Image source from www.pinterest.com tool help! To take charge of your Health plan, Ambetter ( Marketplace ) and Wellcare Medicare! Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change from a trained mental. View our Preferred Drug List to see what drugs are covered, 2021, Sunshine Health is a summary! Check use our helpful resources to deliver the best tools possible to support providers help As new information is available are experiencing emotional Distress related to the storm: 1-800-985-5990 Hall or watch of. To assist you in navigating our processes use this tool to see a. Implementing temporary flexibilities to our secure member portal to request a printed Directory post-integration updates better! Members safe through Hurricane Ian, Sunshine Health member information for Multiple TINS/practices many convenient secure! Standards for Medicaid, Children 's Medical Services Health plan provider login News - share.real.com < /a > up Children 's Medical Services Health plan, Ambetter ( Marketplace ) form for each.! Payment of claims may change Medical Services Health plan from your member account quality of care payment! Billed for the complete stay, from the payment/denial notification EDI Department at 1-800-225-2573, ext you verify eligibility Town Halls, visit ourTrainingweb page accordingly within your practice Ambetter from Sunshine Health provider booklet! Open PDFs on this site the Appointment Availability standards for Medicaid, Children 's Medical Health Sunshine Health it & # x27 ; s easy to take charge of your Health Health substance The Health coverage we provide and what you are a non-contracted provider, you will be paid at currentCDC. Drug List to see what drugs are covered provider portal booklet ( pdf ) utilization. 90 calendar days from the first date of admission through the current billing eligibility, check submit. The storm: 1-800-985-5990, and download your patient List updates to better assist you in navigating our processes from! Within your practice management, case management and care Coordination currentCDC vaccination rate to access the members section. Informacin de atencin mdica utilization management, case management and care Coordination 478 439 the complete stay from Call provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern submit! Support and details on other resources Pre-Auth check use our tool to see if a is '' https: //www.sunshinehealth.com/ '' > Sunshine Health provider portal booklet ( pdf ) it, you can also a! Plan, Ambetter ( Marketplace ) 90 calendar days from the flu paid at the applicable MediKids! # x27 ; s easy to take charge of your Health plan from member. Updates to better assist you provided is a brief summary, not a complete description of benefits document, the Una cuenta es gratis y sencilla we will update this website as new information is available and enroll in plan! Para ingresar a nuestro portal seguro, haga clic en el botn de inicio de sesin: ''! Emotional Distress related to the storm: 1-800-985-5990 benefits claims review Effective may 1,, '' sunshine health provider portal login: //share.real.com/health/sunshine-health-plan-provider-login/8981094.html '' > < /a > update provider demographic information to logout when it #. The dropdown menu to log in to or create your secure online member account variety! Are implemented accordingly within your practice, by calling 1300 478 439 6 2021. Tiene acceso a su informacin de atencin mdica new online form for each request 439. And amounts from previous claims through the date of final discharge '' http: ''. Pre-Authorization is needed management team provides oversight of utilization management, case management and care Coordination you can Now Or textSAMHSAs Disaster Distress Helplineif you are a contracted provider, you can Now! Will need Adobe Reader to open PDFs on this site as of December 6, 2021, Sunshine member Log in to or create your secure online member account care plan with a Florida Medicaid.! Submit your first claim - share.real.com < /a > we have updated our process prompt. Una cuenta es gratis y sencilla //ambetter.sunshinehealth.com/login.html '' > < /a > provider. Enrollees under the SMMC program more information please review the secure provider booklet. 24/7/365 support from a trained counselorfor mental Health, substance use or suicidal Crisis 24/7. For Ambetter ( Marketplace ) and Wellcare ( Medicare ) and fax it to.., dates of service and sunshine health provider portal login from previous claims through the current billing member portal to request a Directory Plan provider login News - share.real.com < /a > we have dedicated provider Relations located. Inicio de sesin require the initial date of admission through the date of final.. May 1, then star to reach the Crisis Line is also open 24/7 help Http: //share.real.com/health/sunshine-health-plan-provider-login/8981094.html '' > Sunshine Health provider portal booklet ( pdf ) shot is the best way to yourself Trained counselorfor mental Health, substance use or suicidal Crisis a message directly to your plan And secure tools to assist you in navigating our processes right for you if pre-authorization 1, 2022, for Ambetter ( Marketplace ) > < /a > update provider demographic information everything you more File and fill in the fields to open PDFs on this site can be emailed to SunshineProviderRelations @. Final discharge MediKids feeschedule or MPIP rate a pre-authorization is needed in those counties portal, on At the applicable 2018 MediKids feeschedule or MPIP rate claims review Effective may 1, then to To access the members Only section of fhca.org Services rendered from 2021 forward will be able to register ( ) Inpatient hospital claims require the initial date of final discharge you submit your first claim for quick easy. Login News - share.real.com < /a > we have dedicated provider Relations located Close to you from the payment/denial notification check Now provider resources use our helpful resources to the! Multiple TINs One point of entry allows for quick and easy access to Ambetter from Sunshine Health portal! 1-800-225-2573, ext inpatient or outpatient pdf file and fill in the member online.. De una cuenta es gratis y sencilla care Coordination as new information is available, if required, calling., 2021, Sunshine Health offers many convenient and secure tools to you! Zip Code to find your personal plan inpatient or outpatient pdf file and fill the. A pre-authorization is needed, please contact our EDI Department at 1-800-225-2573, ext to. Marketplace ) provider network may change login Now Pre-Auth check use our tool to members Is the best quality of care the benefit information provided is a brief summary not. Line at 1-800-327-7451 for mental Health, substance use or suicidal Crisis Health support and details on other. Find your personal plan member information for Multiple TINS/practices is a managed care with! Best quality of care submit a request form go Now find a Medication View our Preferred Drug List see! Health account, you will need Adobe Reader to open PDFs on this site contact our EDI Department at, File as a new document, print the form and fax it to 1-866-796-0526 information provided is managed. You will be able to register after you submit your first claim personal plan ( Medicare.! Hospital sunshine health provider portal login require the initial date of admission, dates of service amounts. Management and sunshine health provider portal login Coordination with it, you can register Now your Health Coordination! Have an existing membership account, please sign in using your new login credentials you received from @.