Skip to Main Content

Send Us An Updated Roster

Date: 11/14/23

Fort Lauderdale, Florida

Sunshine Health requires Community Behavioral Health Service groups to continually update your Affiliated Providers (LOAP)/Practitioner Roster with the Health Plan

Here’s more information about why your group needs to keep updating its roster, what the state requires and tips for fulfilling this Sunshine Health rule:

Why Does it Need to Be Updated?

Sunshine Health wants to ensure we have the most up-to-date information about your group and the practitioners providing services to our members.

AHCA Requirement

AHCA requires that every Community Behavioral Health Services provider who participates with Medicaid or Children’s Health Insurance Program (CHIP) must have at least one group member who is a physician enrolled in Florida Medicaid.

How to Update Your LOAP/Roster

Providers can update their roster by downloading this form:

Tips for filling out the LOAP/Roster

  • Required fields are highlighted in red. Incomplete fields will delay your request.
  • Only one billing NPI can be submitted per LOAP.
  • Only submit practitioners using the service locations where they will treat members.
  • Sunshine Health requires a credentialing staff and public-facing email address to receive our communications.
  • Patient age ranges and gender restrictions must be included in the LOAP.
  • Do not send duplicate rosters.

Documentation required to add “new” practitioners

Note: All these documents are only required if it is a credentialing-required specialty.

  • Completed Practitioner Application with Attestation and Authorization and Release; signed and dated within 120 days of submission for enrollment
  • Access to Council for Affordable Quality Healthcare (CAQH) profile
  • Proof of highest level of education/training
  • Explanation for any employment's gaps of 6 months or greater
  • History of malpractice claims paid within last 5 years
  • Hospital admitting privileges or documented protocol if no privileges exist
  • Supervisor Physician/Collaborative Agreement (NP/PAs only)
  • Copy of current DEA registration, if applicable
  • Copy of current medical license
  • Professional liability coverage
  • Disclosure of Ownership (DOO) every 3 years
  • W-9 (providers should submit an updated W-9 when changes are made, or annually; whichever comes first)
  • If the Primary Care Physician (PCP) is operating from a new location, a site visit must be completed by your Provider Engagement Administrators

Tips for Submitting W-9s

  • Submit Tax ID or name changes to Sunshine Health by emailing: SunshineContracting@sunshinehealth.com.
  • W-9 billing address changes are time-sensitive and should be submitted within 60 days of any changes and/or annually by emailing: Sunshine_Provider_Relations@sunshinehealth.com.
  • Send a W-9 to the Health Plan each time the payment address changes or annually, whichever comes first
  • Failure to comply could cause a misdirection of payment.

Provider Enrollment Tips

  • Community Behavioral Health Services group members must be enrolled in Florida Medicaid and be specialized therapeutic services providers or physicians (M.D. or D.O.)
  • Providers must have a separate Medicaid ID number for all service locations
  • Specialized therapeutic services providers must link to a Community Behavioral Health Services group provider
  • Specialized therapeutic foster care providers must link to a Community Behavioral Health center or a specialized therapeutic services group provider
  • Comprehensive behavioral health assessment providers must link to a specialized therapeutic services group provider
  • Specialized therapeutic foster care groups must have at least one Medicaid enrolled physician with the specialized therapeutic foster care specialty as a group member

Note: The Florida Medicaid Provider Enrollment Policy (PDF) has more details on these requirements.

Questions?

If you have questions, please contact your Provider Engagement Administrator. You can also call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News.

SH_6883