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Sunshine Health Updates Secondary Payer Policy

Date: 03/30/26

At Sunshine Health, we’re committed to making it easier for providers to work with us and ensuring timely, accurate claims processing. To support this, we are updating how prior authorization and claims are handled when Sunshine Health is the secondary payer.

Effective April 28, 2026, if Sunshine Health is the secondary insurer:

  • Do not submit prior authorization requests to Sunshine Health
  • Submit claims directly to Sunshine Health after the primary insurer processes the claim
  • Include the Explanation of Payment (EOP) or Explanation of Benefits (EOB) from the primary insurer with your claim
  • No authorization is required for Sunshine Health to process secondary claims

If the member does not have a primary insurer, follow the standard process and submit prior authorization requests to Sunshine Health as applicable.

Following this updated process will help Sunshine Health quickly and accurately process claims.

Note: The updated secondary payer policy does not apply to Expressive Therapy (ET) providers treating Children’s Medical Services (CMS) Health Plan members.

If you have any questions, please contact your Provider Engagement Account Manager 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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