Manuals, Forms and Resources

Important Provider Notifications

Sunshine Health Advantage (HMO SNP) is publishing its Payment and Clinical Policies to inform providers about acceptable billing practices and reimbursement methodologies for certain procedures and services. For more information, click the Important Provider Notification.

Sunshine Health Opioid Summit Toolkit

Click here for the complete Sunshine Health Opioid Summit Toolkit.

Forms and Resources

Manuals

Payment Policy

Claims Related Forms

General Provider Forms

HEDIS

BMI Graph Tool

Advance Directives

Provider Education

Attention Deficit Hyperactivity Disorder (ADHD)

Fraud, Waste and Abuse

PaperFree Florida

Provider Manuals

Payment Policy

Claims Related Forms

General Provider Forms

Medicare Advantage Resources

Preventive and Clinical Practice Guidelines

HEDIS Quick Reference Guide

HEDIS Tip Sheets

BMI Graph Tool

Provider Education Materials

Fraud, Waste and Abuse

Provider Training

Provider Training – Cenpatico

As the behavioral health partner of Sunshine Health, Cenpatico is able to offer a variety of training topics for LTC, MMA, and child welfare providers. Please visit www.cenpaticou.com to:

Menu of Provider Trainings

  • View our menu of available training topics.
  • See a list of current provider training events.
  • Request topics for future provider webinars.
  • Contact us to inquire about in-person trainings at your facility.
Immunizations

Children must be immunized during medical checkups according to the in accordance with the ACIP periodicity table by age and immunizing agent.

An assessment of the child’s immunization status should be made at each screening and immunizations administered as appropriate.  If the child is due for an immunization, it must be administered at the time of the screening.  However, if illness precludes immunization, the reason for delay should be documented in the child’s record.  An appointment should be given to return for administration of immunization at a later date.

Immunization of children should be provided according to the guidelines recommended the Centers for Disease Control (CDC), the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics, and Florida State Law.

NOTE: HEALTHY KIDS MEMBERS ARE NOT ELIGIBLE FOR THE VACCINES FOR CHILDREN PROGRAM (VFC).  BILL SUNSHINE HEALTH FOR THE VACCINE AS WELL AS THE ADMINISTRATION OF THE VACCINE(Administration fee inclusive of the Vaccine Reimbursement).  Even though the VFC program does not apply to Healthy Kids members, all providers are required to participate in the Fl SHOTS immunization registry.  

Home Health and Durable Medical Equipment Providers

Learn how to maximize reimbursement opportunities by correctly documenting procedure codes and reduce the risk of claims denials. To learn more, click on the Billing and Procedure Coding Guide. 

Ambetter Manuals & Forms

For Ambetter information, please visit our Ambetter website.