Sunshine Health Incentive for After-Hours Availability
Date: 04/16/25
Sunshine Health offers providers a $20 incentive for every member who receives healthcare services after hours. Our goal is to improve members’ access to healthcare, and an effective way to do that is for providers to offer services to their patients outside of their regular office hours.
What is considered after hours?
- Healthcare services rendered from 5 p.m. to 8 a.m. Local Time
- All weekends
- All holidays
- After-hours telehealth services are included
Which providers are eligible?
- Medical Doctors (MDs)
- Doctor of Osteopathic Medicine (DOs)
- Physician Assistants (PAs)
- Psychologists (PhDs)
- Nurse Practitioners (NPs)
- Therapists (Physical, Speech and Occupational Therapy/PT, ST, OT only)
- Therapy Assistants included
Which products are eligible?
- Sunshine Health Medicaid (MMA)
- Comprehensive Long Term Care (LTC)
- Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP)
- Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI)
- Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)
- Children’s Medical Services (CMS) Health Plan
How to indicate after-hours services?
Providers must use one of these procedure codes in addition to an Evaluation and Management (E/M) service code for services scheduled outside regularly scheduled hours:
- 99050: After-hours care provided in provider’s office outside of regular office hours.
- 99051: After-hours care provided during regularly scheduled evening, weekend or holiday office hours.
- 99060: After-hours emergency care.
Note: Modifiers are not needed when reporting after-hours services.
How is Sunshine Health capturing this information?
Sunshine Health will utilize claims data to verify when after-hours services were rendered, which indicates they occurred outside of regularly scheduled hours.
Claim Example
Please remember to indicate both the E&M code and after-hours code.
Corrected Claims
Providers who need to rebill with a corrected claim, please ensure to include both the E&M code and after-hours code.
Standards for Appointment Scheduling
Find the appointment standards for each health plan:
After-hours incentive tips
- Visits that start during regular office hours but ends after hours are not eligible for the incentive.
- Please ensure that your practice informs members about regular office hours and after-hours availability.
- Your website should be updated with your most current office hours and after-hours availability.
Federal Holiday | Day/Date |
|---|---|
Memorial Day | Monday, May 26 |
Juneteenth National Independence Day | Thursday, June 19 |
Independence Day | Friday, July 4 |
Labor Day | Monday, September 1 |
Columbus Day | Monday, October 3 |
Veterans Day | Tuesday, November 11 |
Thanksgiving Day | Thursday, November 27 |
Christmas Day | Thursday, December 25 |
Questions?
Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:
- Provider Services: Call 1-844-477-8313
- Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
- Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
- Provider News: Bookmark Provider News to keep up with the latest updates.
- Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
- Provider Resources: Visit Manuals, Forms and Resources to find provider manuals, important forms and other resources.
SH_9891