Reminder: Required Information for Medicaid Elective Inpatient Authorization Requests
Date: 03/13/26
Sunshine Health reminds hospital providers about the importance of properly utilizing the Inpatient Prior Authorization Fax Form (PDF) to submit prior authorization requests. This is not applicable to emergency room (ER) stays that become concurrent.
Completing the form accurately helps prevent delays in the delivery of healthcare services to your patients, our members.
It is essential that all of the form’s required fields are completed and that drug-specific information is included when it is submitted. It is especially important to include J-code(s) and NDC numbers, if applicable.
Please ensure the following information is included every time an Inpatient Prior Authorization Fax Form (PDF) is submitted:
- Applicable HCPCS/J-code(s)
- National Drug Code (NDC)
- Primary and any additional procedure codes
- Diagnosis code(s) (ICD-10)
- Requested start or admission date
- Servicing facility information
- Supporting clinical documentation, including medical necessity and relevant treatment history
If you have questions about authorization requirements or need help with a submission, contact your Provider Engagement Account Manager (PEAM).
Pe-Auth Check
- Visit the Sunshine Health Pre-Auth Check resource to find the Pre-Auth Check Tools for our health plans and to download prior authorization request forms.
This guidance applies to these products
- Sunshine Health Medicaid (MMA)
- Comprehensive Long Term Care (LTC)
- Children’s Medical Services (CMS) Health Plan
- 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)
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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