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Providers: Learn About Tracking Numbers vs. Authorization Numbers

Date: 03/07/24

Fort Lauderdale, Florida

Sunshine Health knows providers have questions about web portal authorizations. This tip sheet will address those concerns by helping providers learn how to differentiate between tracking numbers and IP/OP authorization numbers:

1.       What is the difference between the tracking number and IP/OP authorization number?

a.       A tracking number is provided when the authorization has been submitted but has not been fully determined.

i.      Example: 8-digit number; 1234-5678

b.       An authorization number is provided once the review has been finalized.

ii.      Example: IP or OP with 10 digits following; OP1234567890

2.       What is the correct number to use for billing?

a.       Providers should use the inpatient (IP) or outpatient (OP) authorization number when submitting claims.

3.      What is the turnaround time (TAT) for authorization determinations in the Provider Portal?

a.       This depends on the authorization type selected. For example, for an urgent request, the provider could receive an immediate response based on the criteria of the request.

b.       If the request requires review, then the normal TAT rules apply from the member’s health plan.

i.      Sunshine Health Medicaid (MMA), Long-Term Care (LTC), Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI) Specialty Plan, and Children’s Medical Services (CMS) Health Plan authorization decision timeframes:
        - Standard Pre-Service: 7 calendar days
        - Expedited Pre-Service: 48 hours
        - Urgent Concurrent (Inpatient): 48 hours
        - Post Service (Retroactive): 30 calendar days

 ii.      Wellcare Medicare authorization decision timeframes:
        - Standard Pre-Service: 14 calendar days
        - Expedited Pre-Service: 72 hours
        - Urgent Concurrent (Inpatient): 72 hours
        - Post-Service (Retroactive): 30 calendar days

 iii.      Wellcare Complete (Wellcare by Allwell) authorization decision timeframes:
        - Standard Pre-Service: 15 calendar days
        - Expedited Pre-Service: 72 hours
        - Concurrent: 3 business days

 iv.      Ambetter (Marketplace) authorization decision timeframes:
        - Pre-Service/Urgent: 72 hours
        - Pre-Service/Non-urgent: 15 calendar days
        - Concurrent/Urgent: 24 hours
        - Retrospective: 30 calendar days

4.       Can the Provider Portal be used to search for tracking numbers?

a.       Yes, tracking numbers are searchable in each health plan’s Provider Portal:
            - MMA, LTC, CWSP, SMI and CMS
            - Ambetter (Marketplace)
            - Wellcare Medicare
            - Wellcare Complete

Sunshine Health’s provider manuals and other resources can help answer your questions:

Questions?

If you have any questions, please call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Our Provider Engagement staff are also here to help answer questions. Visit the Find Your Administrator tool to confirm the individual supporting your specialty and region. We encourage you stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News.

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