CMS Health Plan Transition: Review Claims Submission Requirements

Date: 10/06/26

CMS Health Plan members transitioned from Sunshine Health to Molina Healthcare on October 1, 2026.

Please review the established CMS Health Plan Transition Authorization and Claims Guidance to ensure claims are submitted to the appropriate health plan and to help avoid payment delays or claim processing issues.

The appropriate health plan is determined by the service start date, date of service, or inpatient admission date, depending on the type of request. The guidance also includes submission requirements for claims that spanned the October 1 transition date.

We encourage providers to:

• Review internal billing workflows and procedures
• Ensure billing staff are aware of established processes
• Verify claims are submitted to the appropriate health plan based on applicable dates of service

Thank you for your partnership and continued commitment to serving CMS Health Plan members.

If you have questions, please contact Provider Services at 1-844-477-8313.

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