Provider Services Call Center
Do you need more information or have a question? Call Provider Services at 1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form.
Secure Provider Portal
If you are a contracted Sunshine Health provider, you can register now. If you are a non-contracted provider, you will be able to register after you submit your first claim.
Once you have created an account, you can use the Secure Provider Portal to:
- Verify member eligibility
- Manage claims
- Manage authorizations
- View patient list
Standards for Appointment Scheduling
We want to ensure appointments for medical services and behavioral health services are available to our members on a timely basis. See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Please ensure these standards are implemented accordingly within your practice.
Important Provider Updates
Join a Provider Town Hall
Provider Town Halls cover a variety of post-integration updates to better assist you in navigating our processes. Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. Please register in advance—space is limited. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit our Training web page.
Screening, Brief Intervention and Referral to Treatment (SBIRT)
Sunshine Health values our relationship with our provider partners and are pleased to announce updates for Screening, Brief Intervention and Referral to Treatment (SBIRT) for persons with substance use disorders.
Prompt Payment Notice
We have updated our process for prompt payment of claims. As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule.
Vaccine Coverage for MediKids Enrollees
Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. Services rendered in 2018-2020 will be paid at the applicable 2018 MediKids fee schedule or MPIP rate. Services rendered from 2021 forward will be paid at the current CDC vaccination rate. Any prior underpayments will be reprocessed automatically. Providers do not need to resubmit claims.
Interim Billing Requirements
Starting Feb. 1, 2021, Sunshine Health requires hospital providers to use inpatient type of bill code 0112 interim when billing first-time claims for interim inpatient stays that exceed 100 consecutive days.
For each subsequent inpatient hospital billing, the previous interim claim is voided by being recouped and replaced with the new claim type of bill code 0117. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. The final replacement claim must be billed for the complete stay, from the first date of admission through the date of final discharge.
Questions regarding this update can be emailed to SunshineProviderRelations@Sunshinehealth.com.
Provider Coronavirus Information
We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS), the Florida Department of Health (DOH), the Agency for Health Care Administration (AHCA), and all other applicable agencies as it is released to ensure we can quickly address and support the prevention, screening and treatment of COVID-19. Read provider coronavirus guidance.
Sunshine Health offers health insurance programs that fit the unique needs of our members.
View all of our available programs below. Select one to view more information and resources for our plan.
Health Insurance Marketplace
The Health Insurance Marketplace is an online shopping mall of healthcare plans. Sunshine Health's plan is called Ambetter. Ambetter offers affordable health care coverage for individuals and families. Depending on family size and income, a person may even qualify for help to pay their monthly premium.