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Pre-Auth Check

Pre-Auth Check Tool

Use our tool to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can access our login to submit online.

Prior Authorization

Send request to our Utilization Management Department

Medicaid

Medicare

Behavioral Health

Sunshine Health must approve in advance the services listed below. Prior approval is required for all services by a provider who is not in the Sunshine Health network. The only exception is for emergency care. Emergency room or urgent care visits do not require prior authorization. This list of services below is not all inclusive. Please call our Provider Services help line at 1-844-477-8313 to check if a prior authorization is required or use our online prior authorization look up tool

Services Requiring Prior Authorization

PCPs, Specialists, or Facilities must request an authorization for the following services. Expand the links below to find out more information.

This list indicates which services require a prior authorization. If a prior authorization isn’t received, the claim for any service noted as requiring a prior authorization will be denied. This is not a complete list of covered services. Limits and services that are not covered are listed in the Member Handbook. Our Utilization Management Department is available Monday through Friday from 8 a.m. to 6 p.m. at 1-866-796-0530, during normal working days. Nurse Advice Line staff are available 24/7 for after-hour calls.

 

Last Updated: 09/30/2022