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On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.

Vendors

Sunshine Health has contracted with the following vendors for service:

  • Access Behavioral Health (Medicaid, Child Welfare Specialty Plan, Long Term Care, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-866-477-6725
    • abhinfo@bhcpns.org
    • Delegated function: Coverage of Services (Behavioral Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Behavioral Health Services, in-lieu services, inpatient and outpatient services, Region 1 only
    • Exclusions: Regions 2-11 will be managed by the Health Plan

  • Alivi (Long Term Care, Comprehensive LTC)
    • Reservations: 1-888-863-0248 (TTY 711) between 8 a.m. and 5 p.m. Eastern, Monday through Friday
    • Ride Assist (Where’s My Ride?): 1-888-863-0248 (24/7, 365 days a year)
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee and/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions: Non-Long Term Care and Comprehensive Lines of Business; Emergency Transportation

  • Alivi (Medicare)
    • Reservations: 1-855-519-6684 between 8 a.m. and 5 p.m. Eastern, Monday through Friday
    • Ride Assist (Where’s My Ride?): 1-855-519-6684 (24/7, 365 days a year)
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee &/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions:  Emergency Transportation, Ambulance

  • BioTelemetry (Medicaid, Medicare, Child Welfare Specialty Plan, Long Term Care, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-888-312-2328
    • Delegated function: Coverage of Services (Disease Management)
    • Delegated function description: Care Coordination/Case Management, Disease Management
    • Services: Biometric Screening and monitoring, On-Demand Disease Management Program
    • Exclusions: Ages 0-14

  • CareCentrix (Medicare)
    • 1-800-808-1902
    • Delegated function: Coverage of Services (Home Health)
    • Delegated function description: Utilization Management (authorizations), Claims Services, Network, Credentialing
    • Services: Home Health, Regions 1-7
    • Exclusions: 
      • Durable Medical Equipment (DME), Non-Medicare Lines of Business
      • Home Health in Regions 8-11

  • CareCentrix (Medicare and Ambetter)
    • 1-800-808-1902
    • Delegated function: Coverage of Services (Post-Acute Care}
    • Delegated function description: Utilization Management (authorizations),
    • Services: Post Acute Care
    • Exclusions: Medicaid Lines of Business

  • Central Florida Orthopedics Associates (Medicaid, Long Term Care, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-863-666-3436
    • info@cfosa.com
    • Delegated function: Provider Services
    • Delegated function description: Claims & Provider Payment
    • Services: Claims, Provider Payments, Region 7 only
    • Exclusions: Commercial (Ambetter), Regions 1-6 and 8-11 are managed by the Health Plan

  • Coastal Care Services (Medicaid, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-855-481-0505
    • Delegated function: Coverage of Services (DME, Home Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Toll-Free Provider Help Line
    • Services: DME & Home Health (MMA, CWSP, SMI, CMS)
    • Exclusions: 
      • Home Infusion Services & PDN: managed by the Health Plan for Medicaid Child Welfare Specialty Plan, & Serious Mental Illness.
      • Home Health for Children’s Medical Services Health Plan: Managed by the Health Plan
         
  • Coastal Care Services (Medicare)
    • 1-855-481-0505
    • Delegated function: Coverage of Services (DME, Home Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Home Health: Regions 8-11; DME: Statewide
    • Exclusions: Home Health Regions 1-7

  • Express Scripts (Medicaid, Commercial/Ambetter, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan, Wellcare)
    • 1-800-841-3044
    • Delegated function: Administration and Management Services, Enrollee Services, Provider Services
    • Delegated function description: Pharmacy Benefit Management, Mailing Fulfillment, Network Management, Provider Credentialing & Contracting, Claims & Provider Payment, Toll-Free Provider Help Line
    • Services: Pharmacy Benefit Management

  • Dental MCOs - Services not managed by Sunshine Health
  • Dermatology Network Solutions [parent company Provider Network Solutions] (Medicare)
    • 1-844-222-3535
    • Delegated function: Coverage of Services (Dermatology), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Contracting, Claims & Provider Payment
    • Services: Dermatology
    • Exclusions: All counties except Miami-Dade, Broward, Palm Beach, Martin, St. Lucie will be Managed by the Health Plan

  • DentaQuest (Medicare)
    • 1-833-206-6288
    • Delegated function: Coverages of Services, Enrollee Services, Provider Services, Quality
    • Delegated function description: Utilization Management, Network Management, Provider Credentialing and Recredentialing, Claims Processing, Member Call Center, Provider Call Center, Quality Improvement
    • Services: Dental Services
    • Exclusions: Non-Medicare Lines of Business

  • Envolve Dental (Commercial/Ambetter)
    • 1-855-735-4395
    • Delegated function: Coverage of Services (Dental), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Claims & Provider Payment
    • Services: Dental Services
    • Exclusions: Medicaid, Children's Medical Services Health Plan Title XIX and Title XXI
       
  • Envolve Vision (Medicaid, Commercial/Ambetter, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-800-531-2818
    • Delegated function: Coverage of Services (Vision), Provider Services
    • Delegated function description: Utilization Management (authorizations), Service Authorization, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Vision Services (Optometry, Ophthalmology)


  • Evolent
    • Cardiology
      • Medicare
      • 1-888-999-7713
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management
      • Exclusions: Emergent services, Non-Elective Inpatient Services
    • High-Tech Radiology and Cardiac Imaging
      • Medicaid, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan
      • Child Welfare Specialty Plan
      • Commercial (Ambetter)
      • Medicare
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System,
      • Exclusions: Long Term Care Line of Business
    • Oncology
      • Medicaid (MMA), Medicare, Commercial (Ambetter), Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI) and Children's Medical Services Health Plan (CMS)
      • 1-888-999-7713
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management
      • Exclusions: Long Term Care Line of Business
    • PT, OT, ST Therapy
      • Commercial (Ambetter)
      • 1-800-424-4909
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System
      • Exclusions: Non-Ambetter Line of Business

  • Florida Care Management Services Agency (FCMSA) (Long Term Care)
    • 1-877-462-1200
    • Delegated function: Coverage of Services, Enrollee Services
    • Delegated function description: Care Coordination/Case Management, Utilization Management, Service Authorization, Enrollee Toll-Free Help Line
    • Services: Care Coordination/Case Management, Utilization Management
    • Services: Care Coordination/Case Management, Utilization Management for a subset of members in Regions 9-11
    • Exclusions: Regions 1 to 8

  • GT-Independence (Long Term Care)
    • 1-877-659-4500
    • Delegated function: Coverage of Services, Enrollee Services
    • Delegated function description: Participant Direction Option (PDO), Enrollee Material, Enrollee Toll-Free Help Line, Mailing Fulfillment
    • Services: PDO

  • Health Network One [contracts providers under Therapy Network of Florida] (Medicaid, Child Welfare Specialty Plan, Serious Mental Illness)
    • 1-800-595-9631
    • Delegated function: Coverage of Services (Therapy), Provider Services
    • Delegated function description: Utilization Management (authorizations), Service Authorization, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Only Free Standing Facilities for PT, OT, ST for members 3 years & older
    • Exclusions: Ages 0-2 will be managed by the Health Plan; Outpatient Hospital, PPEC, EIS, Tertiary, Respiratory Therapy

  • Health Network One (Medicare)
    • 1-800-595-9631
    • Delegated function: Coverage of Services (Dermatology), Provider Services
    • Delegated function description: Utilization Management (authorizations), Service Authorization, Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Dermatology
    • Exclusions: All counties except Lake, Orange, Osceola, Seminole will be managed by the Health Plan

  • Hearing Care Solutions (Medicare)
    • 1-866-344-7756
    • Delegated function: Coverage of Services (Hearing), Provider Services
    • Delegated function description: Enrollee Toll-Free Help Line, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Audiology
    • Exclusions: Non-Medicare Lines of Business

  • HearUSA (Medicaid, Commercial/Ambetter, Comprehensive LTC, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-855-242-4935
    • Delegated function: Enrollee Services, Provider Services
    • Delegated function description: Enrollee Toll-Free Help Line, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Audiology
    • Exclusions: Medicare

  • HHAeXchange (Medicaid, Children's Medical Services Health Plan)
    • 1-844-477-8313
    • Delegated function: Coverage of Services, Administration & Management Services
    • Delegated function description: Participant Direction Option (PDO), EVV Vendor, Electronic Visit Verification
    • Services: EVV, Billing Services, Portal

  • LabCorp (Medicaid, Commercial/Ambetter, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-800-845-6167
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing

  • LabCorp (Medicare)
    • 1-800-845-6167
    • Delegated function: Provider Services
    • Delegated function description: Exclusive only for Wellcare Medicare
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Little Havana Activities & Nutrition Center (Long Term Care)
    • 1-305-858-0887
    • Delegated function: Provider Services, Enrollee Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment, Mail Fulfillment
    • Services: LTC Provider Services, Only Regions 9-11
    • Exclusions: Regions 1-8

  • Liberty Dental Plan (Children Medical Services Health Plan Title XXI)
    • 1-888-352-7924
    • Delegated function: Coverage of Services (Dental), Coverage of Services, Provider Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment, Enrollee Material, Enrollee Toll-Free Help Line, Utilization Management, Service Authorization
    • Exclusions: Medicaid, Ambetter, Medicare & Children's Medical Services Health Plan Title XIX

  • Medical Transportation Management (MTM) (Children's Medical Services Health Plan)
    • Routine Reservations: 1-844-399-9469 (TTY 711) between 8 a.m. and 7 p.m. Eastern, Monday through Friday, and 8 a.m. to 5 p.m. Eastern Saturday
    • Ride Assist (Where’s my Ride): 1-888-597-1185 (24/7, 365 days a year)
    • Reservations
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee &/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions: Non-Children’s Medical Services Health Plan; Emergency Transportation

  • Medical Transportation Management (MTM) (Medicaid, Comprehensive LTC, Serious Mental Illness, Child Welfare Specialty Plan, Children's Medical Services Health Plan)
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: HCBS Therapy (art, equine, music, pet)
      • Ages 21 & older for Medicaid, Comprehensive LTC, Serious Mental Illness; Or
      • EPSDT under age 21
    • Exclusions:
      • Under age 21 for Non-Medicaid, Comprehensive LTC, Serious Mental Illness; Or
      • Non-EPSDT under age 21
      • Authorizations are issued by the Health Plan

  • ModivCare (Medicaid, Child Welfare Specialty Plan, Serious Mental Illness)
    • Reservations between 8 a.m. and 5 p.m. Eastern, Monday through Friday:
    • Ride Assist (Where’s my Ride) (24/7, 365 days a year):
    • Reservations
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee and/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions: Non-Medicaid, Child Welfare Specialty Plan, and Serious Mental Illness Lines of Business; Emergency Transportation

  • Premier Eye Care (Medicare)
    • 1-855-749-1911
    • Delegated function: Coverage of Services, Provider Services
    • Delegated function description: Utilization Management, Network Management, Provider Credentialing, Toll-Free Member Calls, Toll-Free Provider Calls, Provider Complaints
    • Services: Vision Services
    • Exclusions: Medicaid, Commercial/Ambetter, Child Welfare Specialty Plan, Long Term Care, Serious Mental Illness, Children Medical Services

  • Quest Diagnostics (Medicaid, Commercial/Ambetter, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-866-697-8378
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing

  • Quest Diagnostics (Medicare)
    • 1-866-697-8378
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor.
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing

  • TurningPoint (Medicaid, Medicare, Commercial/Ambetter, Child Welfare Specialty Plan, Long Term Care, Serious Mental Illness, Children Medical Services)
    • 1-855-415-7483
    • Delegated function: Coverage of Services
    • Delegated function description: Utilization Management, Service Authorization, Toll-Free Provider Help Line, Provider Complaint System
    • Services: Cardiac Procedures and ENT
    • Exclusions: Long Term Care Line of Business