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For Providers

Important Provider Updates

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.

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