Box 31370 Tampa, FL 33631-3370, WellCare Health Plans Mechanical or administrative delays or errors by Sunshine Health or AHCA. If you have any questions, please contact the EDI Department at the email address below. Contact Us Florida Medicaid Sunshine Health. A Sunshine Health representative may contact you regarding your inquiry. The benefit information provided is a brief summary, not a complete description of benefits. It was alleged that the experiment tripled the whooping cough infections in Florida to over one . Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Providers that bill electronically are responsible for filing claims within the same filing deadlines as providers filing paper claims. P.O. Limitations, co-payments and restrictions may apply. Centenes acquisition ofWellCare'sMedicaid products,includingStaywellHealth Plan, will be completeOct. 1, 2021. There are five easy steps to submitting a claim. All requests for reconsideration or adjustment to paid claims must be received within 90 days from the date the notification of payment or denial is received. Sunshine Health uses an imaging process for claims retrieval. Sunshine Health Claims Mailing Address. Get covered with Sunshine Health today. The errors or omissions in claims result in the request for additional information from the provider or other external sources to resolve or correct data omitted from the bill; review of additional medical records; or the need for other information necessary to resolve discrepancies. Sunshine Health's Payer ID is 68069. . (EOP). Medicaid fee schedule rate revisions shall be applied by Sunshine Health. Such claims are not considered clean and therefore cannot be entered into the system. Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. Download the free version of Adobe Reader. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. See if you're eligible to enroll. For more information on electronic filing . Your inquiry will be reviewed. Sunshine Health will also operate the Department of Healths Children's Medical Services Health Plan beginning Oct. 1, 2021. Sunshine State Health Plan Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . You will need Adobe Reader to open PDFs on this site. transaction. Agency for Health Care. Get medical help from doctors via video and phone. 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 Use the CPT-4 or billing codes found on the authorization or referral. If you do not have an ID, sign up to obtain one today. The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics. The claim must have been received within 6 months of the eligibility determination date. Austin . Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. Please submit this information on a W-9 form. P.O. 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. Services rendered in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. Attn: Appeals Department . Florida acknowledged that the company's failures - blamed on technology glitches over nearly three months - were "non-willful." Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. 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. If you must submit paper claims, you must mail to the appropriate payers P.O. In a Workers Compensation case for which Sunshine Health is not financially responsible, the provider should directly bill the employers Workers Compensation carrier for payment. 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. WellCare Health Plans Contact Ambetter In Florida Ambetter from Sunshine Health. Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. Any prior underpayments will be reprocessed automatically. 08/31/21. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Updates to such Medicaid fee schedules (for all provider types and in any form, including but not limited to, Medicaid Bulletins) shall become effective on the date (Fee Change Effective Date) that is the later of: (i) the first day of the month following thirty (30) days after publication by AHCA of such fee schedule updates, or (ii) the effective date of such fee schedule updates as determined by AHCA. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. For Sunshine Health Enrollees, all claims and encounters should be submitted to: Sunshine State Health Plan Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Your billing department will need to submit to the appropriate payer to prevent payment delays. The Enrollee was eligible however the provider was unaware that the Enrollee was eligible for services at the time services were rendered. 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. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. The benefit information provided is a brief summary . For more information contact the Managed Care Plan. Download the free version of Adobe Reader. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. Please review the guidance below and update your system accordingly. 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. In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines. All disputed claims will be processed in compliance with the claims payment resolution procedure as described in this Provider Manual. (1 days ago) Sunshine Health will return claims when billing information does not match the information that is currently in our files. Please remember the following when filing your claim/encounter: For all contracts with reimbursement for services based on AHCAs Medicaid fee for service rates, please note the following: Any reference to the Medicaid Fee-for-Service rates, Medicaid fee schedule, Medicaid state exempt rates or similar term contained in any contract is a reference to the applicable fee schedule used by AHCA as of the date of service to determine payment under the Medicaid FFS Program. Member Services: As of . 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. Copies of claim forms will not be accepted. . Sunshine Health P.O. Review and retain a copy of the error report that is received for claims that have been submitted electronically, then correct any errors and resubmit with your next batch of claims. Your inquiry will be reviewed. Members call any time to reach our 24-hour Nurse Advice Line. The websites below provide information to help providers find answers. Get covered with Sunshine Health today. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Your inquiry will be reviewed. Register for OUD Training. Sunshine Health is a managed care plan with a Florida Medicaid contract. 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. If you are a contracted Sunshine Health provider, you can register now. Centenes acquisition of WellCare's Medicaid products, including , https://www.sunshinehealth.com/newsroom/Guidelines-for-proper-claims-submissions.html, Health (1 days ago) Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. Member Services: As of Sept. 23, 2023, Sunshine Health and CMS Member Services are open as usual from 8 a.m. to 8 p.m. Monday-Friday. 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. Sunshine will take whatever steps are necessary to ensure that the provider is recognized by the state Medicaid program, including the enrollment broker contractor(s) as a participating provider of Sunshine Health Plan, and, that the providers submission of encounter data is accepted by the Florida MMIS and/or the states encounter data warehouse. Sunshine Health is a managed care plan with a Florida Medicaid contract. (Just Now)Sunshine Health P.O. or by e-mail at: 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 If you have an Detail: Visit URL . Please ensure these standards are implemented accordingly within your practice. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . You must request access to our secure site by registering for a user name and password and have requested Claims access. We want your claim submissions processed as efficiently as possible. Sunshine Health Claims Mailing , https://www.health-improve.org/sunshine-health-medicaid-claims-address/, 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 p.m. From April 1 September 30, you can call us , https://wellcare.sunshinehealth.com/contact-us.html, Health (6 days ago) Contact Us Florida Medicaid Sunshine Health. 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 your pharmacy for information. 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. Non-clean claims are submitted claims that require further investigation or development beyond the information contained therein. 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. c/o Centene EDI Department For more information contact the . Crime Statistics for Sarasota County, . Because protecting peoples' health is why we're here, and it's what we'll always do. If you are a non-contracted provider, you will be able to register after you submit your first claim. Your inquiry will be reviewed. Please confirm with your Provider Relations Department that the following information is current in our files: Providers must bill with their NPI number in box 24J of the HCFA 1500 if applicable. Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Required fields are marked with an asterisk (*) 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, Provider National Provider Identifier (NPI), Physical location address (as noted on current W-9 form), The Enrollee is effective on the date of service, The service provided is a covered benefit under the Enrollees contract on the date of service, Referral and prior authorization processes were followed, If you are the provider for a Sunshine Health Enrollee and receive a monthly capitation amount for services, you must file a proxy claim (also referred to as an. Providers must be registered with Florida Medicaid. 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