Manuals, Forms and Resources

Manuals

837 Companion Guide (PDF)

Claims Related Forms

• Provider Dispute Form (PDF)
• W-9 Form (PDF)

General Provider Forms

• File A Complaint
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form - Medicaid (PDF)
• Outpatient Prior Authorization Fax Form - Children's Medical Services Health Plan (PDF)
• Prior Authorization List
• Provider Education – Marketing (PDF)
• Risk Adjustment (PDF)
• Durable Medical Equipment Home Health and Home Infusion Referral Form (PDF)
• Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian (PDF)

BMI Graph Tool

BMI Chart Form (PDF)

Advance Directives

Florida Health Care Association - Health Care Advanced Directives
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PaperFree Florida

• PaperFree Florida Brochure (PDF)
• Get the Facts About Regional Extension Centers (PDF)

Claims Related Forms

• Provider Dispute Form (PDF)
• Multiple Claim Submission Wizard-LTC (PDF)
• How to Complete CMS UB-04 Claim? (PDF)
• W-9 Form (PDF)

Helpful Links

• Assisted Living Facilities Supports and Resources
• The Florida Department of Elder Affairs
• Florida Association of Assisted Living
• DCF
• Veterans Affairs
• Social Security Administration
• Department of Elder Affairs
• Medicare
• My Florida
• AHCA Nursing Home Rates
• Hospice
• Florida Health Finder

Provider Services and Complaints Policy

Provider Services and Complaints Policy (PDF)

General Forms

• File A Complaint
• Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian (PDF)
• Long Term Care Skilled Services Form (PDF)
• Notification of Pregnancy Form (PDF)
• Member Move Form (PDF)

In Lieu of Services Resource Guide

The Medicaid In Lieu of Services Resource Guide (PDF) describes the ILOS benefits, eligibility requirements, limits and prescribing rules.

Claims Related Forms

• Provider Dispute Form (PDF)
• W-9 Form (PDF)

General Provider Forms

• File A Complaint
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Connections Referral Form (PDF)
• Prior Authorization List
• Provider Education – Marketing (PDF)
• Risk Adjustment (PDF)
• Durable Medical Equipment Home Health and Home Infusion Referral Form (PDF)
• Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian (PDF)

HEDIS

• HEDIS Quick Reference Guide (PDF)
• HEDIS Tip Sheet – Adult Measures (PDF)
• HEDIS Tip Sheet – Pediatric Measures (PDF)
• HEDIS Tip Sheet – Well Women Measures (PDF)

BMI Graph Tool

BMI Chart Form (PDF)

PaperFree Florida

• PaperFree Florida Brochure (PDF)
• Get the Facts About Regional Extension Centers (PDF)

Training

• Early Intervention Services and Targeted Case Management for children ages 0 to 3 (PDF)
  • EIS and TCM Billing Tip Sheet (PDF)
  • PaySpan Registration Instructions (PDF)
• Medical Foster Care (PDF)
• Medical Foster Care (Accessible PDF)
  • Medical Foster Care billing and reimbursement guidelines overview (PDF)
  • How to Apply for Your NPI Number (PDF)
• Hospital LARC Billing Instructions for Managed Care (PDF)

General Provider Forms

• Outpatient Prior Authorization Fax Form - Children's Medical Services Health Plan (PDF)

Provider Manuals and Guides

• Provider and Billing Manual - Medicare Advantage (PDF)
• Quick Reference Guide (PDF)
• Allwell from Sunshine Health Provider Toolkit (PDF)

Claims and Payments

Billing

• PaySpan – EFT/ERA
  Allwell from Sunshine Health is pleased to partner with PaySpan Health to provide an innovative web based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs).  This service is provided at no cost to providers and allows online enrollment. 
  Visit PaySpan’s website for more information
• Provider Portal
  If you are a contracted provider, you can register now. View detailed instructions on how to register (PDF). If you are a non-contracted provider, you will be able to register after you submit your first claim. 
• Sunshine Health Payment Policies

Provider Payment forms

• Provider Dispute Form (PDF)
• W-9 Form (PDF)

Medical Management

Prior Authorization Resource

Medicare Pre-Auth Disclaimer: All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent upon eligibility, covered benefits, provider contracts and correct coding and billing practices. For specific details, please refer to the Allwell from Sunshine provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

Authorization Forms

Authorization requests may be submitted by secure web portal and should include all necessary clinical information.

• Medicare Advantage Prior Authorization List - English (PDF)
• Medicare Advantage Prior Authorization List - Spanish (PDF)
• Elective Inpatient Prior Authorization Form (PDF)
• Outpatient Prior Authorization Form (PDF)
  • Please Fax Current Admission and Clinical information to the below:
    • Current Admissions 1-877-808-9369
    • Clinical Information 1-866-796-0527
• Durable Medical Equipment (DME), Home Health & Home Infusion Referral Form (PDF)
• National Imaging Associates (NIA)

Quality of Care

• HEDIS Quick Reference Guide (PDF)
• HEDIS Tip Sheet – Adult Measures (PDF)
• HEDIS Tip Sheet – Pediatric Measures (PDF)
• HEDIS Tip Sheet – Well Women Measures (PDF)

BMI Graph Tool

BMI Chart Form (PDF)

For Ambetter information, please visit our Ambetter website.