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Stay Connected on the Go! Download our Health Insurance Portal mobile app to search for care, view benefits and access your Member ID card. LEARN MORE AND DOWNLOAD THE APP
Stay Connected on the Go! Download our Health Insurance Portal mobile app to search for care, view benefits and access your Member ID card. LEARN MORE AND DOWNLOAD THE APP

PCP Birth Outcomes Incentive Program

Sunshine Health wants to help our Primary Care Providers (PCPs) deliver the best healthcare possible to our members during their pregnancy. We designed the PCP Birth Outcome Incentive program to help PCPs improve the maternal health of our members during an important time in their lives by seeing a member in the first trimester.

Prenatal care is crucial for improving health outcomes for new mothers and their babies. Starting prenatal care early helps providers identify health risks to avoid adverse birth outcomes.

Incentive: Primary Care Providers (PCPs) get $50 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
  • The first incentive payment will be issued in the third quarter of 2026 and the final payment will be issued by June 30, 2027.
  • This incentive closes the Healthcare Effectiveness Data and Information Set (HEDIS) Prenatal Care Gap (PPC).

Note: 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 tool.

Questions?

Contact your Sunshine Health Provider Engagement Account Manager (PEAM) or call Provider Services at 1-844-477-8313.