PT/OT/ST Prior Authorization Change for CMS Members
Date: 08/25/22
Fort Lauderdale, Florida
Thank you for your partnership with Sunshine Health and Children’s Medical Services (CMS) Health Plan. We want to share important information about changes to the prior authorization process for Physical Therapy, Occupational Therapy and Speech Therapy services in outpatient locations for CMS members.
Starting October 3, 2022, outpatient PT/OT/ST authorizations for CMS members should be directed to Sunshine Health instead of eviCore. Authorization requests should be submitted via the Sunshine Health Secure Provider Portal.
Notice
Members will not experience any changes to their therapy benefits.
FAQs
How do providers obtain authorizations for CMS Health Plan members on or after October 3, 2022?
Please submit authorization requests through Sunshine Health’s Secure Provider Portal.
When a CMS Health Plan member has been authorized for services prior to October 3, 2022, and is still in treatment on October 3, 2022, do providers need to obtain a new authorization number?
No, providers do not need to obtain a new authorization number until the authorization expires. When an authorization does expire, a new authorization must be submitted to Sunshine Health for services to continue.
Sunshine Health will be unable to issue an authorization for services prior to October 3, 2022. Sunshine Health will also be unable to re-issue an authorization for services issued by eviCore prior to October 3, 2022. Please contact eviCore at 1-888-333-8641 for authorizations occurring prior to October 3, 2022.
Where do providers submit claims for dates of service rendered on or after October 3, 2022?
Follow the normal claims submission guidelines as documented in the Sunshine Health Provider Billing Manual (PDF).
Contact Us
For questions or concerns, please contact Sunshine Health Provider Services at 1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern. The line is open 24/7 for requests for prior authorization. Stay up to date on providers notices by reviewing and bookmarking Provider News.