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Stay connected when you're away from home! Download our Health Insurance Portal mobile app to find care, view benefits, and access your member ID card. Get more information and download the app.

Private Duty Nursing (PDN) and Personal Care Services (PCS) Authorization Guidance Now In Effect

Date: 09/23/26

Sunshine Health supports the accurate and timely processing of PDN and PCS authorization requests. To help this process, providers should note the following updated guidance regarding date spans and submission practices:

Authorizations that End on the First of the Month

We have identified a recurring issue with requests that include an end date on the first day of a month where no services are being provided on that day.

For example:

  • March 1-31, 2026: 120 hours
  • April 1-30, 2026: 115 hours
  • May 1,  2026: 0 hours

In these scenarios, the inclusion of a date with zero authorized units cannot be accommodated. When a request ends on the first day of a month and no services are rendered on that date, that day should not be included in the authorization period.

Please note:

  • The zero-unit day cannot be combined with or “rolled into” the prior month within the same authorization.
  • An end date submitted with zero units will be removed during processing.
  • If continued services are needed, that date may be included in a subsequent authorization request.

To help avoid processing adjustments or delays, we recommend aligning requested service dates with actual service delivery.

Discharge-Related Requests

Please fax durable medical equipment (DME) and home health (HH) discharge-related requests to: 1-844-801-8413

Note: Failure to use the correct fax line could delay the timely processing of member discharges.

Continuity of Care (CoC)

When a member transitions to Sunshine Health from another health plan during the active authorization period, the provider must include a copy of the prior insurer's approval with your request whenever possible. Providing the previous approval allows Sunshine Health to efficiently review and process the request under CoC guidelines.

If the prior approval letter is unavailable, please include the following information with your service request:

  • Previous insurance carrier name
  • Authorization number
  • Approved service(s)
  • Approved CPT codes
  • Approved dates of service
  • Approved frequency and hours/units

Providing this information at the time of submission will help prevent delays and support timely processing of the request.

If you have questions, please contact your Sunshine Health Provider Engagement Account Manager (PEAM) or call Provider Services at 1-844-477-8313.

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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