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Change in FQHC Credentialing Process

Date: 01/03/24

Fort Lauderdale, Florida

Sunshine Health is implementing a change in our credentialing process, specifically affecting our FQHC provider network. This adjustment is being implemented to align with the rigorous standards set by the National Committee for Quality Assurance (NCQA) and the requirements established by the Centers for Medicare & Medicaid Services (CMS). The core change involves credentialing both the FQHC facility itself and any practitioners listed in our directory who hold specialties necessitating credentialing.

Facility credentialing will commence on February 1, 2024. This process entails a thorough review of the FQHC facility's compliance with federal and state regulations, as well as an assessment of its adherence to quality standards and the qualifications of its providers. In addition to facility credentialing, we will also credential any practitioners within our network who possess specialties that mandate credentialing, as per NCQA guidelines. This dual approach underscores our commitment to ensuring that our members receive care from proficient and well-qualified professionals.

It's important to note that this change will impact all new contracts with our provider network. Additionally, we are working diligently to bring existing facilities up to the new credentialing standards. We kindly request your collaboration in providing the necessary documentation and information to facilitate this transition. Our credentialing team will be on hand to guide you through the process and address any inquiries or concerns you may have.

For our existing, in-network FQHCs, Sunshine Health will need to collect the following documents:

  • Accreditation/Certification, if applicable
    • AHCA inspection report or site visit required if facility is unaccredited.
  • CLIA Certification
  • DEA Certification
  • Disclosure of Ownership Form
  • Facility Credentialing Application
  •  General Liability Insurance (1M/3M minimum)
  • State Operational License
  • W-9

We recognize that adapting to change can be challenging, but we firmly believe that this adjustment will ultimately lead to an enhanced quality of care for our members. Should you have immediate questions or require further clarification, please don't hesitate to reach out to Provider Services at 1-844-477-8313. Your continued partnership and commitment to delivering high-quality healthcare services are deeply appreciated. Together, we can ensure that our FQHC provider network remains in step with the latest industry standards.

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