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Behavior Analysis Network Exception Request Form

Please note providers should attempt the following prior to submitting an Exception Request:

  • Assign any Sunshine Health/CMS members to an in-network practitioner
  • Engage Sunshine Health/CMS Case Management that can assist members/families locating and coordinating with another in-network provider
  •  Contact Sunshine Health Customer Service for list of in-network BA providers
  • Utilize the Find a Provider Tool to identify additional in-network providers

Provider Information

Please no dashes "-"
Reason for Exception Request (Select all that apply) required *

Impacted Member Information

Request Submitted By

Required Attachments

Please note all requests will be reviewed by Sunshine Health within 30 days to determine if an exception needs to be made. The goal is to ensure members are serviced by in-network providers who have been through the credentialing and onboarding process.