Thank you for caring for our members by utilizing Sunshine Health programs and resources to help mothers deliver healthy babies. Over the past year, your participation helped ensure healthy outcomes for mothers and newborns.
To continue supporting our shared vision of improving birth outcomes in Florida, we are pleased to announce we are continuing our Birth Outcomes Provider Incentive program. The program’s incentive is tied to Notification of Pregnancy (NOP) forms. The incentive is paid monthly.
$50 for NOP forms submitted through our Secure Provider Portal within 30 days of the first prenatal visit.
To provide the best care and support for our members, it is critical that we receive an NOP form for every pregnant member immediately after she leaves your office. The sooner we learn our members are expecting, the sooner we can reach out to them with support and services designed to lead to healthy pregnancies and deliveries. To be eligible for the incentive payment, providers must submit the NOP through the Secure Provider Portal and place their Tax ID Number (TIN) in the OB Provider ID field. For more information, please see the Frequently Asked Questions below.
Notification of Pregnancy (NOP) Frequently Asked Questions
Which providers are eligible for the Notification of Pregnancy (NOP) incentive?
Any participating Sunshine Health maternity provider is eligible to receive the incentive.
What products are included in this incentive?
Sunshine Health’s Medicaid, Serious Mental Illness (SMI) Specialty Plan, Child Welfare Specialty Plan and Children’s Medical Services (CMS) Health Plan products are included.
How do providers submit an NOP to be considered for payment?
Any NOP that is received through the Sunshine Health Secure Provider Portal between Jan. 1, 2023, and Dec. 1, 2023, will be considered for payment. The member must be enrolled with Sunshine Health on the date of service for payment to be made.
Are any members excluded?
Yes. Sunshine Health is not including any member whose Medicaid category is SSI with Medicare. This exclusion is because Medicare is the primary insurance for these members.
Is there a number of members a maternity provider must see to qualify for this incentive program?
No. Any of our participating maternity providers are eligible to participate. If there is one member for whom an NOP is completed, the maternity provider can participate.
How does Sunshine Health determine which maternity provider is paid?
For the NOP, payment is made to the maternity provider who is seeing the member for that pregnancy. We realize that our members may switch maternity providers during pregnancy. In these cases, payment can be made to another maternity provider, when they submit an NOP, after their first prenatal visit with that member.
Do providers need to take any additional steps to get paid?
Yes. It is important that Sunshine Health has an up-to-date W9 form as payments will be made by check. To ensure checks are sent to the correct address, a current W9 must be emailed to Sunshine Health at Sunshine_Accounts_PA@centene.com.
How will providers be paid?
On a monthly basis, Sunshine Health will determine if a maternity provider has provided services that meet the criteria for this incentive. Providers will be sent a separate monthly check for incentives earned. The memo line in the check will note “maternity incentive.” Providers can find details on members who qualified and for whom the payment is made through our Secure Provider Portal. Click Provider Analytics, then Reports.
When will providers be paid?
On a monthly basis, Sunshine Health will identify which members had qualifying services for the previous month. Payment will be made for each qualifying activity for that previous month. The payment will be made the month after the NOP has been submitted.
Are there other supports for at-risk pregnant Sunshine Health members?
Yes. Optum offers other in-home support for at risk pregnant members. Programs include gestational/pre- gestational diabetes, gestational hypertension, preeclampsia, preterm labor, and nausea and vomiting during pregnancy. You can refer members to Optum by calling 1-800-950-3963.
Sunshine Health also has our Start Smart for Your Baby maternity program. This program provides individualized, comprehensive care for expectant mothers and newborns to ensure healthy pregnancies and deliveries. The program is offered at no cost to members. Our care management team provides support for maternity education, coordinates care with maternity providers and other specialists, and helps connect the member to community resources, such as WIC, Healthy Start, SNAP and other services that address social determinates of health. Encourage your Sunshine Health patients to enroll by calling Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
How can providers refer Sunshine Health members to the Start Smart for Your Baby maternity program?
A referral can be made through our Secure Provider Portal. It will be sent to our case management team so they can reach out to the member. You can also call Provider Services at 1-844-477-8313 and select the prompt for case management.
How do I register for the Sunshine Health Secure Provider Portal?
Go to the Secure Provider Portal and create an account.
What information is in the Secure Provider Portal?
Inside the Secure Provider Portal, you can access tools and functions to help you verify coverage eligibility, track your incentive payments and view customized Provider Analytic reports.
Is there information that must be completed in the NOP?
Yes. There are required fields in the NOP. These are essential so that Sunshine Health can correctly identify you as the maternity provider submitting the NOP, the correct member and essential information about the member’s pregnancy. Details about the member’s current and past pregnancies are used to help Sunshine Health identify those who may be at risk for a poor birth outcome. See the Notification of Pregnancy Form and the fields noted with an * as required. In order to receive the incentive, the NOP must be completed through the Secure Provider Portal.
How do providers submit a NOP through the Secure Provider Portal?
There are 3 easy steps to submit an NOP:
- Open patient’s chart in Secure Provider Portal, and click Assessments
- Click Fill Out Now
- Complete all fields, then click Submit at the end.