Manuals, Forms and Resources
Manuals
- Medicaid (MMA), Comprehensive Long Term Care (LTC), Sunshine Health Pathway to Shine Specialty Plan (CWSP), Sunshine Health Mindful Pathways Specialty Plan (SMI) and Sunshine Health Power to Thrive Specialty Plan (HIV) Provider Manual (PDF)
- Children's Medical Services (CMS) Health Plan Provider Manual (PDF)
Forms
- Provider Dispute Form (PDF)
- Provider Claim Adjustment Request Form (PDF)
- Provider Incident Notification Form (PDF)
- Provider Interpreter Request Form (PDF)
- Outpatient Single Case Agreement (PDF)
Standards for Appointment Scheduling
Additional Resources
Manuals
Claims Related Forms
General Provider Forms
- Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian (PDF)
- Behavior Analysis Prior Authorization Request Form (PDF)
- Durable Medical Equipment Home Health and Home Infusion Referral Form (PDF)
- 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)
- Outpatient Treatment Requests (OTR) Tips
- Prior Authorization List
- Provider Education – Marketing (PDF)
- Request for an Appeal or Grievance Form (PDF)
- Risk Adjustment (PDF)
- Supplemental Outpatient Authorization Form (PDF)
BMI Graph Tool
Advance Directives
Florida Health Care Association - Health Care Advanced Directives
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PaperFree Florida
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 describes the ILOS benefits, eligibility requirements, limits and prescribing rules.
Claims Related Forms
General Provider Forms
- File A Complaint
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Supplemental Outpatient Authorization 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)
BMI Graph Tool
PaperFree Florida
Training
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. - Sunshine Health Payment Policies
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.
- Medicare Advantage Prior Authorization List - English (PDF)
- Medicare Advantage Prior Authorization List - Spanish (PDF)
- Supplemental Outpatient Authorization Form (PDF)
- Durable Medical Equipment (DME), Home Health & Home Infusion Referral Form (PDF)
- National Imaging Associates (NIA)
BMI Graph Tool
For Ambetter information, please visit our Ambetter Health website.