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Prior Auth Changes for Targeted Case Management (TCM) and Psychosocial Rehabilitation (PSR) Services

Date: 05/14/25

Starting August 1, 2025, Sunshine Health will require prior authorization for all Targeted Case Management (TCM) and Psychosocial Rehabilitation (PSR) services for members ages 4 years old and above.

This change will not apply to members under 4 years old. While this change will take place in August, the health plan will begin accepting TCM (T1017) and PSR (H2017) authorization requests on June 1, 2025.

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. 

What provider types does this apply to?

  • Community Behavioral Health Services (05)
  • Specialized Therapeutic Services (07)
  • Residential and Freestanding Psych (16)
  • Social Worker/Case Manager (32)
  • Case Management Agency (91)

What products does this apply to?

  •  Sunshine Health Medicaid (MMA)
  • Comprehensive Long Term Care (LTC)
  • Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP)
  • Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI)
  • Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)
  • Children’s Medical Services (CMS) Health Plan (Including Title 19 and 21)

Questions?

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

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