Value-Based Incentive Programs
Thank you for caring for our members by utilizing Sunshine Health programs and resources to help our members live healthy lives.
We know that proactively engaging our members for needed health services can take administrative time and effort. The programs listed below are designed to support you in these proactive efforts.
These programs will reward you for engaging our members in needed care, like timely follow-up care after an inpatient behavioral health (BH) admission or for following evidenced-based guidelines for monitoring children and adolescents who are taking antipsychotic medications.
You will also receive financial incentives for your participation in our maternal health incentive programs to help ensure healthy outcomes for mothers and newborns.
As valued health providers, you are automatically enrolled in these incentive programs. Sunshine Health will calculate the payments based on claims when care is provided. See details below.
Note: Providers with capitated agreements are not eligible for incentive programs.
Programs | Description | Incentive |
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All Providers: After-Hours Availability Incentive | Sunshine Health offers incentives to providers who deliver care for members after their regular office hours to encourage greater access to care at unexpected times. |
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Behavioral Health: Metabolic Monitoring of Antipsychotics | Behavioral health (BH) providers are incentivized to proactively engage members to provide metabolic monitoring for children and adolescents on antipsychotics. | $200 for ensuring blood glucose and cholesterol tests are done. |
Behavioral Health: 7-Day Follow-Up | Behavioral health (BH) providers are incentivized to proactively engage members to ensure a follow up visit takes place after an inpatient admission. | $100 for follow-up visit after a discharge from a hospitalization for mental health or an intentional self-harm diagnosis. |
Assisted Living Facilities (ALFs): Community Co-Stars Incentive Program | Rewards Assisted Living Facilities (ALFs) for helping members live in a community setting after they transition from a custodial nursing home. | $300 per month, for up to 12 months, for each member that remains in the ALF for a minimum of 16 days each month post nursing home transition. |
Maternal Health: C-Section Birth Incentive for Obstetricians (OBs) | Sunshine Health offers an incentive to Obstetricians (OBs) who meet C-section birth targets in their Agency for Healthcare Administration (AHCA) region. | $500 per quarter to OBs who meet the C-section birth target set in their ACHA region for a total of up to $2,000 for the year. |
Maternal Health: Medication Assisted Treatment (MAT) Incentive | Sunshine Health offers an incentive to Obstetrician-Gynecologists (OB/GYNs) or Behavioral Health (BH) providers who support the use of MAT services (medications, counseling and behavioral therapies) to treat substance use disorders. | $100 incentive payment for each claim filed per pregnant member who receives MAT services provided by an appropriately trained OB/GYN or BH provider. |
Maternal Health: Notice of Pregnancy (NOP) Incentive | The Notification of Pregnancy (NOP) form brings the pregnant member, provider and health plan together and allows Sunshine Health to start important services and benefits to ensure a healthy pregnancy and childbirth. | $100 for each NOP form submitted within 30 days of a member’s first prenatal visit. |
Maternal Health: PCP Birth Outcomes Incentive Program | Sunshine Health offers an incentive to Primary Care Providers (PCPs) to get their pregnant patients in for an exam during their first trimester to ensure both the mother and fetus are healthy. | $25 for each pregnant member a PCP sees in the member’s first trimester. |
Maternal Health: Preterm Birth Incentives for Obstetricians (OBs) | Sunshine Health offers an incentive to Obstetricians (OBs) who help their pregnant patients avoid the serious complications and health risks associated with preterm births. | $500 per quarter to OBs who meet the preterm birth target set by the state in their AHCA region for a total of up to $2,000 a year. |
Maternal Health: Screening, Brief Intervention, and Referral to Treatment (SBIRT) Incentive | Sunshine Health offers an incentive to providers who complete a Screening, Brief Intervention, and Referral to Treatment (SBIRT) assessment within each pregnant member’s first trimester. | $50 for every SBIRT assessment a provider completes for a pregnant member during their first trimester. |
Maternal Health: Social Determinants of Health (SDOH) Incentives | Sunshine Health offers incentives to providers who submit detailed claims or encounters using SDOH ICD-10-CM Z Codes. Social Determinant of Health (SDOH) are nonmedical factors that can influence health outcomes such as economic, environmental and social conditions. |
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W-9 Tax Form
Providers must have an updated W-9 tax form on file with the health plan to ensure no disruptions in payment. To update your W-9, utilize the Provider Demographics Update web form.