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Stay connected when you're away from home! Download our Health Insurance Portal mobile app to find care, view benefits, and access your member ID card. Get more information and download the app.
Stay connected when you're away from home! Download our Health Insurance Portal mobile app to find care, view benefits, and access your member ID card. Get more information and download the app.

Vendors

Sunshine Health has contracted with the following vendors for service:

  • Access Behavioral Health (Medicaid (MMA), Sunshine Health Pathway to Shine Specialty Plan (CW), Sunshine Health Mindful Pathways Specialty Plan (SMI), and Sunshine Health Power to Thrive Specialty Plan (HIV))
    • 1-866-477-6725
    • abhinfo@bhcpns.org
    • Delegated function: Coverage of Services (Behavioral Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Behavioral Health Services, in-lieu services, inpatient and outpatient services in  Escambia, Okaloosa, Santa Rosa and Walton only
    • Exclusions: All other counties will be managed by the Health Plan
  • Alivi (Medicaid, CW, Comprehensive LTC, Long Term Care, SMI, HIV)
    • Reservations between 8 a.m. and 5 p.m. Eastern, Monday through Friday; and Ride Assist (Where’s My Ride?) 24/7, 365 days a year
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee and/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions: Emergency Transportation; Air Ambulance
  • Alivi (Medicare)
    • Reservations: 1-855-519-6684 between 8 a.m. and 5 p.m. Eastern, Monday through Friday
    • Ride Assist (Where’s My Ride?): 1-855-519-6684 (24/7, 365 days a year)
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee &/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions:  Emergency Transportation, Ambulance
  • CareCentrix (Medicare)
    • 1-800-808-1902
    • Delegated function: Coverage of Services (Home Health)
    • Delegated function description: Utilization Management (authorizations), Claims Services, Network, Credentialing
    • Services: Home Health in Region A to E only
      • Region A: Escambia, Okaloosa, Santa Rosa and Walton, Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington
      • Region B: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union, Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
      • Region C: Pasco and Pinellas
      • Region D: Hardee, Highlands, Hillsborough, Manatee, Polk
      • Region E: Brevard, Orange, Osceola, and Seminole
    • Exclusions: 
      • Durable Medical Equipment (DME), Non-Medicare Lines of Business
      • Home Health in Regions F to I
        • Region F: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
        • Region G: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
        • Region H: Broward
        • Region I: Miami-Dade and Monroe
  • CareCentrix (Medicare and Ambetter Health)
    • 1-800-808-1902
    • Delegated function: Coverage of Services (Post-Acute Care}
    • Delegated function description: Utilization Management (authorizations),
    • Services: Post Acute Care
    • Exclusions: Medicaid Lines of Business
  • Centene Dental Services (Commercial/Ambetter Health)
    • 1-855-735-4395
    • Delegated function: Coverage of Services (Dental), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Claims & Provider Payment
    • Services: Dental Services
    • Exclusions: Medicaid
  • Centene Vision will continue to manage routine eye care services and full-scope of licensure optometric services for Sunshine Health.
    Sunshine Health will be responsible for the following functions for ophthalmologists providing medical eye care services beginning January 1, 2027, to include:
    • Contracting, Credentialing
    • Claim Processing, Claim Appeals
    • Provider Services
    • Provider Relations/Account Management
    • Provider Education and Resource Materials (Provider Manual, Training)
    • Provider Web Portal
    • Prior Authorization, Retrospective Utilization Review, Medical Necessity Appeals
    • Provider Complaints
  • Central Florida Orthopedics Associates (Medicaid, SMI, HIV, Medicare)
    • 1-863-666-3436
    • info@cfosa.com
    • Delegated function: Provider Services
    • Delegated function description: Claims & Provider Payment
    • Services: Claims, Provider Payments, Counties: Orange, Seminole, and Osceola
    • Exclusions: Long Term Care, Child Welfare, Commercial (Ambetter Health), All counties except Orange, Seminole, and Osceola
  • Coastal Care Services (Medicaid, CW, SMI, HIV)
    • 1-855-481-0505
    • Delegated function: Coverage of Services (DME, Home Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Toll-Free Provider Help Line
    • Services: DME & Home Health (MMA, CW, SMI)
    • Exclusions: 
      • Home Infusion Services, Diabetic Shoes & Private Duty Nursing (PDN): managed by the Health Plan for Medicaid CW, & SMI.
  • Coastal Care Services (Medicare)
    • 1-855-481-0505
    • Delegated function: Coverage of Services (DME, Home Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: DME: Statewide; Home Health: Regions F to I
      • Region F: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
      • Region G: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
      • Region H: Broward
      • Region I: Miami-Dade and Monroe
    • Exclusions: Home Health Regions A to E
      • Region A: Escambia, Okaloosa, Santa Rosa and Walton, Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington
      • Region B: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union, Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
      • Region C: Pasco and Pinellas
      • Region E: Hardee, Highlands, Hillsborough, Manatee, Polk
    • Additional Exclusions:
      • Customized Equipment: Power Operated Vehicle (POV)/Custom Wheelchair
      • Diabetic Supplies, Insulin pumps, and all applicable Supplies
      • ESRD Related Services
      • High Frequency Chest Wall Oscillation
      • Home Health —Nursing visits in excess of 4 hours a day
      • Home Infusion Medication and Home Infusion Nursing
      • Implantable Devices
      • Life Vest Defibrillator
      • Mental Home Health Services
      • Neuromuscular stimulators
      • Orthotics and Prosthetics
      • Parenteral Nutrition and all applicable Pump and Supplies
      • Specialty Bed (i.e., Clinitron)
      • Speech Generating Devices
      • Transplant related services
      • Negative Pressure Wound Therapy Pump (NPWT) (E2402)
        • NPWT Dressings (A6550) | Disposable Canister for NPWT (A7000)
        • Including KCI Wound Vac and other NPWT manufactures
          • NOTE: Procedure code A7000 will be paid by Coastal Care if billed alone and/or without A6550 and E2402
  • Dermatology Network Solutions [parent company Provider Network Solutions] (Medicare)
    • 1-844-222-3535
    • Delegated function: Coverage of Services (Dermatology), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Contracting, Claims & Provider Payment
    • Services: Dermatology (Miami-Dade, Broward, Palm Beach, Martin and St. Lucie counties)
    • Exclusions: All counties except Miami-Dade, Broward, Palm Beach, Martin, St. Lucie will be Managed by the Health Plan; non-Medicare lines of Business
  • Dental MCOs – (Medicaid dental benefits are not administered by Sunshine Health)
  • DentaQuest (Medicare)
    • 1-833-206-6288
    • Delegated function: Coverages of Services, Enrollee Services, Provider Services, Quality
    • Delegated function description: Utilization Management, Network Management, Provider Credentialing and Recredentialing, Claims Processing, Member Call Center, Provider Call Center, Quality Improvement
    • Services: Dental Services
    • Exclusions: Non-Medicare Lines of Business
  • Express Scripts (Medicaid, Commercial/Ambetter Health, CW, SMI, Wellcare, HIV)
    • 1-800-841-3044
    • Delegated function: Administration and Management Services, Enrollee Services, Provider Services
    • Delegated function description: Pharmacy Benefit Management, Mailing Fulfillment, Network Management, Provider Credentialing & Contracting, Claims & Provider Payment, Toll-Free Provider Help Line
    • Services: Pharmacy Benefit Management
  • Evolent
    • Cardiology
      • Aged 21 or older (Medicaid, Comprehensive LTC, CW, SMI, HIV, Medicare, Ambetter Health)
      • 1-888-999-7713
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management,
        Service Authorization, Notice of Adverse Benefit Determination Issuance & Completion, Toll-Free Provider Help Line
        • Exclusions:
          • Emergent services, Non-Elective Inpatient Services
          • Aged 20 or younger Medicaid, Comprehensive LTC, CW, SMI, HIV, and Medicare Lines of Business
          • Aged 18 or younger Ambetter Health
          • Long Term Care Line of Business
    • High-Tech Radiology, Cardiac Imaging and Musculoskeletal
      • Medicaid, Comprehensive LTC, SMI, HIV
      • CW
      • Commercial (Ambetter Health)
      • Medicare
      • Web Portal
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Notice of Adverse Benefit Determination Issuance & Completion, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System
      • Exclusions: Long Term Care Line of Business
    • Oncology
      • Medicaid, Medicare, Commercial (Ambetter Health), Comprehensive LTC, CW, SMI, HIV
      • 1-888-999-7713
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System
      • Exclusions: Long Term Care Line of Business
    • PT, OT, ST Therapy
      • Commercial (Ambetter Health)
      • 1-800-424-4909
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Notice of Adverse Benefit Determination Issuance & Completion, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System
      • Exclusions: Non-Ambetter Health Lines of Business
  • Florida Care Management Services Agency (FCMSA) (Long Term Care)
    • 1-877-462-1200
    • Delegated function: Coverage of Services, Enrollee Services
    • Delegated function description: Care Coordination/Case Management, Utilization Management, Service Authorization, Enrollee Toll-Free Help Line
    • Services: Care Coordination/Case Management, Utilization Management
    • Services: Care Coordination/Case Management, Utilization Management for a subset of members in Palm Beach, Broward and Miami-Dade only all other counties (will be managed by the Health Plan)
    • Exclusions: All other counties
  • GT-Independence (Long Term Care)
    • 1-877-659-4500
    • Delegated function: Coverage of Services, Enrollee Services
    • Delegated function description: Participant Direction Option (PDO), Enrollee Material, Enrollee Toll-Free Help Line, Mailing Fulfillment
    • Services: PDO
  • Health Network One (Medicare)
    • 1-800-595-9631
    • Delegated function: Coverage of Services (Dermatology), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, and Claims & Provider Payment
    • Services: Dermatology (Lake, Orange, Osceola and Seminole counties)
    • Exclusions: All counties except Lake, Orange, Osceola, Seminole will be managed by the Health Plan; Non-Medicare lines of Business
  • Hearing Care Solutions (Medicare)
    • 1-866-344-7756
    • Delegated function: Coverage of Services (Hearing), Provider Services
    • Delegated function description: Enrollee Toll-Free Help Line, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Audiology
    • Exclusions: Non-Medicare Lines of Business
  • HearUSA (Medicaid, Commercial/Ambetter Health, Comprehensive LTC, CW, SMI, HIV)
    • 1-855-242-4935
    • Delegated function: Enrollee Services, Provider Services
    • Delegated function description: Enrollee Toll-Free Help Line, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Audiology
    • Exclusions: Long Term Care and Medicare
  • HHAeXchange (Medicaid)
    • 1-844-477-8313
    • Delegated function: Coverage of Services, Administration & Management Services
    • Delegated function description: Participant Direction Option (PDO), EVV Vendor, Electronic Visit Verification
    • Services: EVV, Billing Services, Portal
  • LabCorp (Medicaid, Commercial/Ambetter Health, CW, SMI)
    • 1-800-845-6167
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • LabCorp (Medicare)
    • 1-800-845-6167
    • Delegated function: Provider Services
    • Delegated function description: Exclusive only for Wellcare Medicare
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Little Havana Activities & Nutrition Center (Long Term Care)
    • 1-305-858-0887
    • Delegated function: Provider Services, Enrollee Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment, Mail Fulfillment
    • Services: LTC Provider Services, in Palm Beach, Broward and Miami-Dade only
    • Exclusions: All other counties
  • Premier Eye Care (Medicare)
    • 1-855-749-1911
    • Delegated function: Coverage of Services, Provider Services
    • Delegated function description: Utilization Management, Network Management, Provider Credentialing, Toll-Free Member Calls, Toll-Free Provider Calls, Provider Complaints
    • Services: Vision Services
    • Exclusions: Medicaid, Commercial/Ambetter Health, CW, Long Term Care, SMI
  • Quest Diagnostics (Medicaid, Commercial/Ambetter Health, CW, SMI)
    • 1-866-697-8378
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Quest Diagnostics (Medicare)
    • 1-866-697-8378
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor.
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Surgery One (Medicaid, SMI, HIV, Medicare)
    • 1-352-275-5478
    • Delegated function: Provider Services
    • Delegated function description: Claims & Provider Payment
    • Services: Claims, Provider Payments, Counties: Orange, Seminole, and Osceola
    • Exclusions: Long Term Care, Child Welfare, Commercial (Ambetter Health), and all counties except Orange, Seminole, and Osceola