Authorization Request with Non-Billable Diagnosis Codes to be Returned

Date: 08/24/22

Fort Lauderdale, Florida

Sunshine Health follows the Centers for Medicare & Medicaid Services’ guidelines for ICD-10 diagnosis codes. Starting September 1, 2022, authorization requests that include non-billable diagnosis codes will be returned to the provider for resubmission.

If you submit an authorization request online through the provider portal with a non-billable diagnosis code, you will receive an error message and you will be asked to resubmit the correct billable diagnosis code. If you fax an authorization request with a non-billable diagnosis code, you will get a fax in return with the same explanation.

Sunshine Health is committed to ensuring that authorizations are processed in a timely manner.
Use the CMS 2022 ICD-10-CM guide to help find the correct, billable ICD-10 code.

If you have questions about this notice, please call Sunshine Health Provider Services at 1-844-477-8313. Stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News.