Reminder: Targeted Case Management (TCM) and Psychosocial Rehabilitation (PSR) Changes
Date: 08/06/25
Sunshine Health reminds providers about important changes now in effect for all Targeted Case Management (TCM) and Psychosocial Rehabilitation (PSR) services:
- Sunshine Health now requires prior authorization for all TCM and PSR services for members ages 4 years old and above.
- Sunshine Health no longer covers PSR services (code H2017) delivered via telehealth.
How to submit Prior Authorization requests
Online: The preferred method is to submit prior auth requests via our Secure Provider Portals:
Fax: Complete and fax the Outpatient Authorization Fax Form (PDF) to the Behavioral Health team at 1-844-208-9113.
Reminder: Use the Pre-Auth Check Tool to check if pre-authorization is needed for any service.
Questions?
Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:
- Provider Services: Call 1-844-477-8313
- Provider Portal: Login 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.
- 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 provider resources.
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