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Maternity Incentive Programs

Sunshine Health thanks providers for caring for our members by utilizing our programs and resources to help mothers experience safe pregnancies and deliver healthy babies.

We offer an array of incentive programs to help providers to ensure healthy outcomes for both mothers and their newborns.

Note: Providers with capitated agreements are not eligible for incentive programs.

C-Section Birth Incentive for Obstetricians (OBs) 

Goal: C-section births can be a life-saving procedure for mothers and their newborns when medical conditions complicate labor and delivery. But there are concerns that this procedure has become overused, and it comes with major risks: hemorrhaging, infections, uterine scarring, infertility, and future pregnancy problems. Sunshine Health wants to reduce these complications by encouraging obstetricians (OBs) to reduce C-section births.

Incentive: OBs can earn an additional $500 per quarter if they meet the C-section birth target set in their ACHA region for a total of up to $2,000 for the year.

Medicated Assisted Treatment (MAT) Incentive

Goal: Sunshine Health knows how critical it is to treat pregnant women with Opioid Use Disorder (OUD) through Medication-Assisted Treatment (MAT), the use of medication, counseling, and behavioral therapies to treat substance use disorders. Infants born to opioid users may suffer from Neonatal Abstinence Syndrome (NAS) and can experience preterm births, low birth weights, sepsis, feeding difficulties, tremors, seizures, and breathing problems. The American College of Obstetricians and Gynecologists (ACOG) recommends MAT because it is safe for pregnant women to take methadone or buprenorphine while breastfeeding. Sunshine Health also offers MAT training to providers to help them treat their patients.

Incentive: Trained Obstetrician-Gynecologists (OB/GYNs) and Behavioral Health (BH) providers can qualify for an additional $100 per claim filed per pregnant member for MAT services.

Visit Medication Assisted Treatment (MAT) Incentive

Training: Sunshine Health offers free, self-paced training sessions to help providers with the 8-hour training requirement for all Drug Enforcement Administration (DEA)-registered practitioners on the treatment and management of patients with opioid or other substance use disorders.

Visit Medication Assisted Treatment (MAT) Training

Notification of Pregnancy (NOP) Incentive

Goal: Sunshine Health knows this important document confirming that a member is pregnant is crucial to the future wellbeing of their new family. 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.

Incentive: Providers can receive $100 for each Notification of Pregnancy (NOP) form submitted within 30 days of a member’s first prenatal visit.

Visit Notice of Pregnancy (NOP) Incentive

Preterm Birth Incentives for Obstetricians (OBs)

Goal: Sunshine Health wants to safely reduce the number of preterm births because of the health risks facing babies born after 37 weeks or earlier. Organs such as the brain, lungs and liver are still developing up until birth, and prematurely born babies may face health complications at birth and later in life. In 2022, babies born too early (before 32 weeks) and at a low weight accounted for about 14% of infant deaths, according to the CDC. Obstetricians (OBs) can reduce preterm births by encouraging their patients to seek prenatal care early in their pregnancies, helping them to avoid alcohol, drugs and smoking during their pregnancies, and seeking medical attention if they experience early signs of preterm labor.

Incentive: OB providers can earn an additional $500 per quarter if they meet the preterm birth target set by the state in their AHCA region for a total of up to $2,000 a year.

  • Sunshine Health utilizes claims data to verify preterm births.
  • The incentive is applied at the Taxpayer Identification Number (TIN) level of the provider/group.
  • OB providers must have a minimum of 25 deliveries per quarter.
  • Note: Providers can qualify for all four quarters.
  • For more information and to view the AHCA regional targets, visit Preterm Birth Incentives for Obstetricians (OBs)

PCP Birth Outcomes Incentive Program

Goal: Sunshine Health believes the best way to prevent undetected and untreated health risks from impacting a pregnancy is to discover them beforehand. We encourage Primary Care Providers (PCPs) to get their patients in for an examination early in their pregnancies to ensure that both the mother and fetus are healthy. Babies of mothers who do not get prenatal care are three times more likely to have low birth weights and five times more likely to die than those born to mothers who do receive prenatal care, according to the Office on Women’s Health.

Incentive: PCPs get $25 for each pregnant member they see in the first trimester.

  • The first prenatal care visit must occur during the patient’s first trimester, which is 280-176 days prior to delivery or the estimated delivery date.
  • Live birth deliveries from January 1 to October 7, 2026, are eligible for the incentive.
  • For more information visit PCP Birth Outcomes Incentive Program

Screening, Brief Intervention, and Referral to Treatment (SBIRT) Incentive

Goal: Sunshine Health believes it is crucial to help pregnant women with substance disorders. Substance use during pregnancy is a common and harmful condition that often ends up being ignored or managed poorly. It is associated with poor outcomes such as preterm births, low birthweights, birth defects, developmental delays, and miscarriages. Sunshine Health encourages providers to engage their patients in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, an evidence-based approach that encourages behavioral changes.

Incentive: Providers who complete the Screening, Brief Intervention, and Referral to Treatment (SBIRT) assessment within each member’s first trimester are eligible for a $50 reimbursement per member.

Social Determinants of Health (SDOH) Incentive

Goal: Social, economic, and environmental conditions can have a significant impact on the health and quality of life of pregnant women. Sunshine Health wants to address the Social Determinants of Health (SDOH) of our pregnant members so we can improve their  outcomes and well-being before, during and after birth.

Incentive: Sunshine Health offers providers additional reimbursement to ensure our members receive assistance for their SDOH by submitting detailed claims or encounters using SDOH ICD-10-CM Z Codes. Z Codes represent factors that influence health status and any contact with health services that may be recorded as diagnoses.

SDOH Incentives:

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.