Expressive Therapy (ET) Quick Reference Guide (QRG)
Sunshine Health covers Expressive Therapy (ET) services that allow members to undergo art, equine, music and pet therapy. Art therapy is a form of psychotherapy that uses art forms such as drawing, painting, modeling, etc. to encourage free self-expression and empowerment. Equine therapy is a range of treatments that involve activities with horses and other equines to promote human physical and mental health. Music therapy includes interventions tailored to a member's specific needs and can address cognitive, emotional, physical, behavioral and social functioning. Pet therapy is a guided interaction between a person and a trained animal (usually with the animal’s handler) to help members recover from, or cope with, a health problem or behavioral health disorder. Providers should utilize this educational guide to supplement the information outlined in our Provider Manuals.
Note: Sunshine Health will directly manage ET services starting January 1, 2026. Effective that date, Medical Transportation Management (MTM) will no longer oversee ET services for our members. To learn more about this transition, or to learn how to join the Sunshine Health network, consult the following links:
- Sunshine Health to Directly Manage Expressive Therapy Network
- Expressive Therapy Provider Medicaid Enrollment Guide
- Florida Medicaid Enrollment Application
- Sunshine Health Network Participation Request Form
This Quick Reference Guide (QRG) covers the following products:
- Sunshine Health Medicaid (MMA)
- 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)
Utilize these methods to verify member eligibility. These suggestions are not a guarantee of coverage.
- Verify member eligibility by using the Sunshine Health Secure Provider Portal.
- Using the portal, any registered provider can quickly check member eligibility using two datasets:
- The member’s date of service, member name and date of birth
- The member’s Medicaid identification number and date of birth
- Note: The correct plan type must be selected
- Note: The correct plan type must be selected
Coordination of Benefits
- Member Coordination of Benefits (COB) information can also be found via the Secure Provider Portal.
Providers can also call Provider Services at 1-844-477-8313. Be prepared to share the member’s name and date of birth or the member’s Medicaid identification number and date of birth.
For all newly enrolled members, Sunshine Health allows for a Continuity of Care (CoC) period for ET services, as well as for other services that the member received prior to enrolling with Sunshine Health.
CoC period: 60 days
This means that a provider with a Medicaid ID and certification for the therapy they are providing can submit claims to Sunshine Health for rendering ET services to members without having a contract in place.
All expressive therapies require Prior Authorization before beginning services. If you have questions, please refer to our Pre-Auth Check Tool.
Sunshine Health
Use Sunshine Health’s secure portal to check a member’s eligibility, verify benefits, submit a referral to Case Management, submit claims, submit claim reconsiderations, etc.
Sunshine Health Portal: Secure Provider Portal
Availity Essentials
Many of the same functions described above can be completed using the Availity portal. We will inform providers when new functionalities are released.
- Availity Portal: Availity Essentials
- Availity Client Services: If you need assistance, call 1-800-AVAILITY (1-800-282-4548). Assistance Monday through Friday from 8 a.m. to 8 p.m. Eastern.
Prior-authorization requests are processed by Sunshine Health’s Utilization Management (UM) Department. All Expressive Therapies require authorization before providing services.
- Standard Hours of Operation: Monday to Friday from 8 a.m. to 8 p.m. Eastern
- Weekend and After-Hours on Call-Numbers: 1-844-477-8313
- Medical Fax: 1-866-796-0526
- Pharmacy Services Fax: 1-833-546-1507
- Forms: Utilize these Treatment/Service Request Forms for fax submission online
- Standard requests: Determination within five calendar days of receipt of request.
Our Case Management team can be reached Monday to Friday from 8 a.m. to 8 p.m. Eastern via the phone numbers below. For after hours or weekend assistance, use option 7.
- MMA, SMI and HIV: 1-866-796-0530, option 2
- CWSP: 1-855-463-4100, option 2
- After Hours or Weekends, option 7
Sunshine Health Payer ID: 68069
Covered Services
- Art Therapy
- Equine Therapy
- Music Therapy
- Pet Therapy
Process for Claims Reconsiderations and Disputes
- All requests for corrected claims or reconsiderations/claim disputes must be received within 90 days from the date of the original explanation of payment or denial. Providers have the option to file a second-level reconsideration/claims dispute. Second-level requests must be received within 90 days from the date indicated on the decision correspondence from the first-level request.
- Quick Tip: Reconsiderations can be submitted via the Sunshine Health Secure Provider Portal in response to an underpaid or denied claim. Providers will know this option is available when the Reconsider Claim button appears within the Claims Details screen.
Electronic Claims Submissions
Electronic claims can be submitted via the Secure Provider Portal or the EDI clearing houses listed. The names and contact information to set up accounts with a clearing house are:
- Availity
- Availity Portal: Availity Essentials
- Availity Client Services: If you need assistance, call 1-800-AVAILITY (1-800-282-4548). Assistance Monday through Friday from 8 a.m. to 8 p.m. Eastern.
- Change Healthcare
- Visit: Change Healthcare
- Call: 1-866-371-9066
Paper Claims Submission
- Medical Claims
Sunshine Health
Attn: Claims Department
PO Box 3070
Farmington, MO 63640-3823
Note: Clean Claims must contain the correct CPT billing code and modifier when appropriate. Additionally, the claim should contain the National Provider Identifier (NPI) and Correct Taxonomy Code.
Billing: The following codes are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply subscriber coverage or provider reimbursement. The codes listed below are not a complete list. Please refer to your Sunshine Health contract to determine all contracted/covered codes for each membership group.
Code | Mod | Description of Service and Limits | Per Unit |
|---|---|---|---|
G0176 | NA | Art and Music Therapy | Session |
G0176 | HQ | Art and Music Therapy - Group | Session |
S8940 | NA | Equine Therapy with Certified Instructor | Session |
S8940 | NA | Equine Therapy with Licensed Therapist | Session |
S8940 | HQ | Equine Therapy - Group | Session |
90899 | NA | Pet Therapy | Session |
90899 | HQ | Pet Therapy - Group | Session |
Please Note: Sessions are at least forty-five (45) minutes in length.
Important Links
- Sunshine Health Expressive Therapy Provider Medicaid Enrollment Guide
- Sunshine Health Manuals, Forms and Resources
Claim Payment Disputes
This includes untimely filing, incidental procedure and unlisted procedure code.
Sunshine Health
Attn: Adjustments/Reconsiderations/Disputes
P.O. Box 3070
Farmington, MO 63640-3823
Provider on Behalf of Self – Medical Appeals
Providers can request an appeal for the following types of denials:
- No authorization claims denials.
- Authorization denials due to member not meeting medical necessity authorization denials and medical necessity, in addition to, benefits exhausted and non-covered procedures.
Sunshine Health
Attn: Adjustments/Reconsiderations/Disputes
P.O. Box 3070
Farmington, MO 63640-3823
For more information about the process, visit the Medicaid Member and Provider Appeals Processes Guide
Overpayment Refund Address
When a facility, group or practice identifies an overpayment, a refund should be sent to the address below and include all applicable claims for which the refund is being submitted.
Sunshine Health
Attn: Centene Mgmt. Co - Sunshine State Health Plan
P.O Box 947986
Atlanta, GA 30394-7986
Claim Concerns
Sunshine Health strives to resolve claim issues promptly and accurately. Providers should follow the appeal and reconsideration procedures outlined in the Provider Manual (PDF) when submitting requests.
If, after following these steps, further review is required, please utilize our Claim Concerns form to resolve the issue. The review process can take up to 30 business days to complete. All claim reviews are subject to timely filing restrictions as detailed in our provider manuals and contractual agreements.
Status Check: Wait 30 days, then to check on the status of your request call Provider Services at 1-844-477-8313
If you are currently receiving paper checks and would like to switch to Electronic Funds Transfer (EFT), please register with PaySpan.
Contact PaySpan via the following channels:
Note: If your address is incorrect in PaySpan, please update it using the Provider Demographic Updates Tool or by calling Provider Services at 1-844-877-8313.
We encourage providers to keep their demographic information up-to-date using our online tool.
Providers can use our online tools to add a new practitioner or facility, start the credentialing process or update your Affiliated Providers (LOAP)/Practitioner Roster.
Enrollment Tools: Provider Enrollment Requests Form
Credentialing Tools: Credentialing
Note: Practitioners should not begin servicing Sunshine Health members until they have received a Provider Enrollment Confirmation letter from Sunshine Health’s Provider Enrollment department. Our enrollment process can take up to 60 days to complete. We will not backdate effective dates due to services provided ahead of the practitioner’s enrollment.
Provider Terminations
Providers can use the Provider Demographic Updates Form to submit these requests.
Medicaid (MMA)
- Provider Services: All Products
- Call: 1-844-477-8313 (All products)
- Hours: Monday through Friday from 8 a.m. to 8 p.m. Eastern
- Member Services: MMA & SMI
- Call: 1-866-796-0530
- Hours: Monday through Friday from 8 a.m. to 8 p.m. Eastern
- Member Services: CWSP
- Call:1-855-463-4100
- Hours: Monday through Friday from 8 a.m. to 8 p.m. Eastern
- Member Services: HIV
- Call: 1-866-796-0530
- Hours: Monday through Friday from 8 a.m. to 8 p.m. Eastern
Learn about our Provider Engagement Account Managers (PEAMs) and how they can help you and your practice. Our teams are regionally based and directly engage with parents and providers in the community. Our PEAMs can meet with you in-person or virtually to assist with a variety of services designed to support you and your child’s success. The following channels will help you contact Sunshine Health and stay informed about the latest policies, procedures and news:
- Provider Services: Call 1-844-477-8313
- Secure 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 resources.
The Nurse Advice Line can assist providers with checking member eligibility. It can also connect members to telemedicine for urgent care visits. Hours of operation are 24 hours a day, 7 days a week.
- MMA/SMI/HIV: 1-866-796-0530 and follow prompts for Nurse Advice Line, then option 1, option 3 and option 7.
- CWSP: 1-855-463-4100 and follow prompts for Nurse Advice Line, then option 1, option 2 and option 7.
If you are struggling with alcohol or drug use, experiencing ongoing anxiety or depression or undergoing a crisis, contact the 988 Lifeline using the options most convenient to you. Services are confidential, free of charge and available 24/7, 365 days a year.
- 988 Lifeline
- Call or Text: 988
- Chat with a Trained Counselor
Training
Sunshine Health offers a wealth of Provider Training opportunities. Providers and their staff can register for our live Provider Town Halls, which are held virtually and in-person; view videos of past webinars; or take self-paced online classes.
Telehealth
Members have 24/7 access to receive services virtually through our telehealth vendors below. Providers may furnish and receive payment for covered, eligible telehealth services in accordance with this policy and the provider’s scope of practice. Telehealth Guide & Best Practices
Access and Availability Timeframe Standards
Sunshine Health establishes and assesses provider compliance with appointment wait times for various types of visits. View Access and Availability Timeframe Standards to find the guidelines that apply to your organization.
Find A Provider (FAP) Tool
The Find a Provider Tool can help members find a specialist or facility. Search by provider name, National Provider Identifier (NPI) and specialty type.
Community Resources
Sunshine Health Connects links members and caregivers in need with local programs and support.
Vendors
Visit Vendors to find subcontractors and vendors and how to contact them.