Learn How the Medicaid Member and Provider Appeals Process Works
Date: 03/02/26
Sunshine Health gives members and providers the right to appeal decisions that affect their care and services. To help navigate this process, we created a Medicaid Member and Provider Appeal Processes Frequently Asked Questions Guide to explain the differences and similarities between the member and provider appeal processes.
This will help medical professionals and their patients understand the key steps, timelines and requirements for filing their respective appeals. And it will help providers better advocate for their patients — and help members better advocate for themselves.
This Guidance Applies to These Products
- 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)
Appeals Guide
View the Medicaid Member and Provider Appeals Processes Guide
Questions?
Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:
- Provider Support: Finding the Right Contact
- Provider Services: Call 1-844-477-8313
- Secure 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.
- Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
- 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, scheduling standards and other resources.
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