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Sunshine Health to introduce Availity Editing Services (AES) in March 2026

Date: 02/10/26

Sunshine Health is introducing Availity Editing Services (AES) to make it even easier for providers to do business with us.

Starting in March 2026, Centene will partner with Availity to return rejection messages on its behalf via AES messages. These messages will be shown in your existing workflows. AES will give you an option, but not a requirement, to edit a claim.

AES can identify a claim error upfront and return a message to you for correction before sending the claim on to the plan to be adjudicated. You should review edit messages for potential corrections to the suggested claim line(s).

If you make updates to the claim, this may help the claim process correctly the first time, preventing errors, improving payment accuracy, and claims adjudication turnaround time. If, after reviewing the message, you find it does not apply, please resubmit the claim as-is. This will allow a bypass of the edit in cases where it may not be applicable.

This is not intended as a new method to deny a claim, nor does it bypass or replace downstream edits. If you choose to bypass an edit, it is possible that other downstream edits will still function as normal in our claims systems. Remember to “submit” your claim regardless of your choice to edit or bypass. This action is required for the claim to be processed in our systems.

If you have a Practice Management System (PMS), you can locate your edits report within your claims workbasket or queue reporting. If you submit claims via the Availity portal, any of these rejections will show on your normal reports.

What’s Changing?

Providers will start seeing real-time rejection messages from Sunshine Health through Availity, directly in your current workflow. These messages help identify claim errors early, giving you the option (not a requirement) to correct and resubmit before the claim goes to the health plan for processing.

How AES Will Help Providers

  • Reduce errors and speed up payments
  • Improve claim accuracy
  • Reduce turnaround time

How AES Works

  1. Review the AES message in your PMS or the Availity portal
  2. Decide whether to update the claim
  3. If the message doesn’t apply, you can resubmit as-is (this bypasses the edit)
    Note: Whether you edit or bypass, be sure to submit the claim so it can be processed

Please Note

  • AES is not a denial tool and doesn’t replace downstream edits
  • If you use a PMS, check your claims workbasket or queue reports for edits
  • If you submit via the Availity portal, edits will appear in your standard reports

Learn More About AES

Login to the Availity Essentials Portal to watch Availity’s free webinars and learn how to:

  • Access and manage AES reports
  • Find your edit reports in Availity Essentials
  • Learn how your Availity administrator can set up reporting preferences

Join Availity Now

Benefits include the ability to check eligibility and benefits, manage claims, submit prior authorizations, and complete other secure administrative tasks in a secure, multi-payer platform. Providers can enroll in Availity Essentials by having their organization’s administrator register on the Availity portal, entering key details, and assigning user roles.

For assistance with registering for Availity Essentials, call Availity Client Services at 1-800-AVAILITY (1-800-282-4548) Monday through Friday from 8 a.m. to 8 p.m. Eastern.

For general questions, please reach out to your Sunshine Health Provider Engagement Account Manager (PEAM).

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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