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Manuals, Forms and Resources

Provider Manual

Medicaid (MMA), Comprehensive Long Term Care (LTC) and Child Welfare Specialty Plan (CWSP) Provider Manual (PDF)

Billing Manual

Medicaid Provider Billing Manual (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

General Provider Forms

HEDIS

BMI Graph Tool

PaperFree Florida

Training

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.  

Provider Manuals and Guides

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. 

Provider Payment forms

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.

Quality of Care

BMI Graph Tool

For Ambetter information, please visit our Ambetter website.