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Ensure Correct Taxonomy on Sunshine Health, CMS Health Plan Claims

Date: 09/11/25

It is critical that providers use the correct taxonomy code on all Sunshine Health (MMA) and Children’s Medical Services (CMS) Health Plan claims.

For Medicaid products, the provider’s taxonomy code must align with the AHCA Provider Master List (PML). The health plan will not update the taxonomy code unless the provider’s NPI number matches the PML.

Why This Matters

  • Using the correct taxonomy code is essential for Medicaid billing.
  • Providers should confirm that the taxonomy used matches what is listed in their Medicaid enrollment records and aligns with the AHCA PML.
  • This helps ensure accurate processing and supports regulatory compliance.

Providers Should Always

  • Verify that the taxonomy used on your claims matches the one listed in the AHCA PML and aligns with the list that Medicaid health plans use to verify that provider networks are enrolled in Medicaid.
  • Ensure alignment with AHCA guidelines and other applicable agency requirements.
  • Review and update records as needed to prevent billing issues.

Billing and Claims

Sunshine Health’s Billing and Claims resource has links to Quick Reference Guides (QRGs) for specific specialties.

Questions?

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

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