You can count on us to share helpful information about COVID, how to , Health (7 days ago) Contact Us Allwell from Sunshine Health Health (1 days ago) Provider Services: 1-877-935-8022 (TTY: 711) From October 1 March 31, you can call us 7 days a week from 8 a.m. to 8 , https://www.health-improve.org/sunshine-health-claims-phone-number/, Health (3 days ago) This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. Sunshine Health MMA: 1-866-796-0530 (TTY 1-800-955-8770) Sunshine Health Child Welfare Specialty Plan: 1-855-463-4100 (TTY 1-800-955-8770) For more information on electronic filing, contact: Sunshine State Health Plan Box 31370 Tampa, FL 33631-3370, WellCare Health Plans Mechanical or administrative delays or errors by Sunshine Health or AHCA. All participating providers must submit claims or encounter data for every Enrollee within the timely filing limit which is 180 days of the date of service. Please review the guidance below and update your system accordingly. Ambetter can help. P.O. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Prior processing will be upheld for reconsiderations or adjustments received outside of the 90 day timeframe, unless a qualifying circumstance is offered and appropriate documentation is provided to support the qualifying circumstance. If you have a life threatening emergency, please contact 911. Sunshine Health values our relationship with our provider partners and are pleased to announce updates for Screening, Brief Intervention and Referral to Treatment (SBIRT) for persons with substance use disorders. . For more information on electronic filing, contact: Sunshine State Health Plan c/o Centene EDI Department 1-800-225-2573, extension 25525 . Category: Health View Health P.O. Claims missing the requirements in bold will be returned,and a notice sent to the provider, creating payment delays. For questions on specialty drugs, call 1-866-796-0530. Box 31368 Tampa, FL 33631-3368. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a managed care plan with a Florida Medicaid contract. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a managed , https://www.sunshinehealth.com/providers/Billing-manual.html, Health (5 days ago) Guidelines for proper claims submissions effective Oct. 1, 2021. Changes to a Providers Tax Identification Number and/or address are NOT acceptable when conveyed via a claim form. The Enrollee was eligible however the provider was unaware that the Enrollee was eligible for services at the time services were rendered. Sunshine Health uses an imaging process for claims retrieval. For more information contact the Managed Care Plan. There are no changes, as PaySpan Health will continue to be the provider of Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) free solutions. A clean claim means a claim . Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Medicare crossover claims must be submitted within 90 days after final determination of the primary payer which is not to exceed 3 years from the date of service. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Contact your pharmacy for information. For more information contact the . These plans require a referral to see specialists. Claims eligible for payment must meet the following requirements: Payment for service is contingent upon compliance with referral and prior authorization policies and procedures, as well as the billing guidelines outlined in this manual. Ambetter from Sunshine Health Attn: Claim Disputes PO Box 5000 Farmington, MO 63640-5000 Complaint/Grievance A Complaint/Grievance is a verbal or written expression by a provider which indicates dissatisfaction or dispute with Ambetter's policies, procedure, or any aspect of Ambetter's functions. Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months . There are five easy steps to submitting a claim. . You will need Adobe Reader to open PDFs on this site. Read provider coronavirus guidance. Molina Healthcare: 1-855-322-4076 or MFLProviderServices@MolinaHealthcare.com Staywell: 1-866-334-7927 or MLTCproviders@wellcare.com Sunshine Health: 1-866-796-0530 or Sunshine Health HHAeXchange: FLsupport@hhaexchange.com Sunshine Health is a managed care plan with a Florida Medicaid contract. Provider must ensure that all data and documents submitted to Sunshine Health, to the best of your knowledge, information and belief, are accurate, complete or truthful. Services rendered from 2021 forward will be paid at the currentCDC vaccination rate. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a managed care plan with a Florida Medicaid contract. In Florida, WellCare Health Plans and Sunshine Health are bringing our health plans together to better serve our members, providers, partners and communities. Providers needing personal assistance can call Sunshine Health: Medicaid/Healthy Kids: 866-796-0530 Child Welfare: 855-463-4100 Ambetter: 877-687-1169 Medicare: 877-935-8022 Your inquiry will be reviewed. 4.Reimbursement will be sent to the Plan subscriber (see Help Sheet for definition) at the address Ambetter from Sunshine Health has on record (To view your address of record, please log on to Ambetter.SunshineHealth.com or call Member Services at 1-877-687-1169 (Relay Florida: 1-800-955-8770) Quick Links PRE AUTH CHECK SUBMIT CLAIM/CHECK CLAIM STATUS TRAINING Become A Provider Provider News Show Do you need more information or have a question? Members call any time to reach our 24-hour Nurse Advice Line. Member Services: As of . Members on our Value Plans can receive services from any Primary Care Provider in the CMG network, which can be found using our Ambetter guide. All requests for reconsideration or adjustment to paid claims must be received within 90 calendar days from the date the notification of payment or denial is received. Contact Us Florida Medicaid Sunshine Health Health Please fill out the below form or contact us at 1-866-796-0530 . Qualifying circumstances include: Consideration is granted in this situation only if all of the following conditions are met: When submitting a paper claim for review or reconsideration of the claims disposition, a copy of the EOP must be submitted with the claim, or the claim must clearly be marked asRE-SUBMISSION and include the original claim number.Failure toboldlymark the claim as a resubmission and include the claim number (or include the EOP) may result in the claim being denied as a duplicate, or for exceeding the filing limit deadline. Farmington, MO 63640-3823 Get covered with Sunshine Health today. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. (1 days ago) , https://www.health-improve.org/sunshine-health-claims-address/, Health (1 days ago) (1 days ago) Contact Us Florida Medicaid Sunshine Health. Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. All claims and encounter data must be submitted on either an original form CMS 1500, UB 04, or by electronic media in an approved format. For participating providers who have internet access and choose not to submit claims via Electronic Data Interchange (EDI), Sunshine Health has made it easy and convenient to submit claims directly to us on our website atwww.sunshinestatehealth.com. The benefit information provided is a brief summary, not a complete description of benefits. The state is giving Sunshine 30 days to pay the fine. We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS), the Florida Department of Health (DOH), the Agency for Health Care Administration (AHCA), and all other applicable agencies as it is released to ensure we can quickly address and support the prevention, screening and treatment of COVID-19. Limitations, co-payments and restrictions may apply. Register for OUD Training. The QRGs include targeted claims and authorization instructions per provider type. Pending or retroactive Enrollee eligibility. Agency for Health Care. Copies of claim forms will not be accepted. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. 1-800-225-2573, extension 25525 The San Francisco Chronicle, December 17, 1979, p. 5 reported a claim by the Church of Scientology that the CIA conducted an open-air biological warfare experiment in 1955 near Tampa, Florida, and elsewhere in Florida with whooping cough bacteria. Ambetter Claims address and Phone Number - Lists Payer ID Claims Address . Sunshine State Health Plan To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, EDI: Professional (837P) service date for all claim lines is located in Loop 2400 (DTP*472*from-through~), EDI: Professional (837P) earliest service date in all claim lines is located in Loop 2400 (DTP*472*from-through~), EDI: Institutional statement date is located in Loop 2300 (DTP*434*from-through~). Requests are processed within 2-business days. Crime Statistics for Sarasota County, . All disputed claims will be processed in compliance with the claims payment resolution procedure as described in this Provider Manual. See if you're eligible to enroll. Box 459089 Fort Lauderdale, FL 33345 , https://www.health-improve.org/sunshine-health-claims-address-for-fl/, Health (2 days ago) Contact Us Florida Medicaid Sunshine Health. There are many ways to get in touch with us, and resources available on our website: Existing The claim must have been received within 6 months of the eligibility determination date. Providers may submit in writing, with all necessary documentation, including the EOP for consideration of additional reimbursement. Your inquiry will be reviewed. and the UB04/837 facility claim forms. " Sunshine waives any dispute not raised within 21 days," the government had warned the company March 17. WellCareMedicare products,claims and correspondence proceduresare not changing at this time. Medicaid fee schedule rate revisions shall be applied by Sunshine Health. Sunshine Health Florida Claims Address Health (Just Now) (Just Now) Sunshine Health P.O. Any prior underpayments will be reprocessed automatically. Provider Billing Manual for Medicaid, Comprehensive Long Term Care and Child Welfare Specialty Plan (PDF). New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. Sunshine Health Claims Mailing Address. If you do not have an ID, sign up to obtain one today. Your inquiry will be reviewed. If you have an Detail: Visit URL . Such claims are not considered clean and therefore cannot be entered into the system. or by e-mail at: The benefit information provided is a brief summary, not a complete description of benefits. Your inquiry will be reviewed. A Sunshine Health representative may contact you regarding your inquiry. Your inquiry will be reviewed. Date: 08/31/21. Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Health (1 days ago) Contact your pharmacy for information. The benefit information provided is a brief summary, not a complete description of benefits. Non-clean claims are submitted claims that require further investigation or development beyond the information contained therein. Use the same date of service guidance on the first page to determine the correct payer. If billing a professional submission with services spanning before and after Oct. 1, 2021, please split the services into two separate claim submissions as outlined below. Please register in advancespace is limited. Attn: Appeals Department Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 a.m.-8 p.m. Eastern Sunshine Health is a Please ensure these standards are implemented accordingly within your practice. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. If you are a non-contracted provider, you will be able to register after you submit your first claim. Services rendered in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. You will need Adobe Reader to open PDFs on this site. There are , https://www.health-improve.org/sunshine-health-ambetter-claims-address/, Health (6 days ago) Ambetter Telehealth. This joining of our organizations will allow us to become a more robust health plan and enhance the delivery of best-in-class care to our members. EDIBA@centene.com. When submitting claims where other insurance is involved, a copy of the EOB or rejection letter from the other insurance carrier must be attached to the claim. Sunshine Health's Payer ID is 68069. . Download the free version of Adobe Reader. Submit all claims/encounters with the proper provider NPI and /or Tax ID Number, Submit all claims/encounters with the Enrollees complete Medicaid number. Contact Us Florida Medicaid Sunshine Health. (Just Now)Sunshine Health P.O. P.O. Always bill the primary diagnosis in the first field. For more information contact the Managed Care Plan. . Providers must be registered with Florida Medicaid. To contact a Provider Services representative, call 1-844-477-8313. (1 days ago) Sunshine Health will return claims when billing information does not match the information that is currently in our files. For questions on medical or behavioral health authorizations, call 1-844-477-8313. An agency spokesperson confirmed Friday that Sunshine State did not file any administrative challenge before the deadline. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Member Services: As of October 27, 2022, Sunshine Health and CMS Member Services are open as usual from 8 a.m. to 8 p.m. Monday-Friday. Date: Health (Just Now) Florida Medicaid & Health Insurance Sunshine Health. (1 days ago) Contact Us Florida Medicaid Sunshine Health. Providers needing personal , https://www.cenpatico.com/providers/fl.html, Health (4 days ago) 4.Reimbursement will be sent to the Plan subscriber (see Help Sheet for definition) at the address Ambetter from Sunshine Health has on record (To view your address of record, , https://ambetter.sunshinehealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL-Reimbursement-Form.pdf, United healthcare exchange find a provider, Valley medical center behavioral health, Silver spring healthcare center milwaukee, Allegheny county health department permit, Providence digestive health santa monica, 2021 health-improve.org. Limitations, co-payments and restrictions may apply. Your inquiry will be reviewed. See Electronic Claims Submission for more information on how to initiate electronic claims/encounters. Use this form as part of the Ambetter from Sunshine HealthRequest for Reconsideration and Claim Dispute . If you have any questions, please contact the EDI Department at the email address below. Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. A Sunshine Health representative may contact you regarding your inquiry. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service. Download the free version of Adobe Reader. The websites below provide information to help providers find answers. Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. Your billing department will need to submit to the appropriate payer to prevent payment delays. If you must submit paper claims, you must mail to the appropriate payer's P.O. You may view web claims, allowing you to re-open and continue working on saved, un-submitted claims and this feature allows you to track the status of claims submitted using the web site. Network providers are encouraged to participate in Sunshine Healths Electronic Claims/Encounter Filing, Program. Starting Feb. 1, 2021, Sunshine Healthrequires hospital providers to use inpatient type of bill code 0112 interim when billing first-time claims for interim inpatient stays that exceed 100 consecutive days. You will need Adobe Reader to open PDFs on this site. Providers that bill electronically are responsible for filing claims within the same filing deadlines as providers filing paper claims. Once you have created an account, you can use the Secure Provider Portal to: We want to ensure appointments for medical services and behavioral health services are available to our members on a timely basis. 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