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Healthcare is essential. Providers do not need to resubmit claims. WellCare Health Plans As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. (1 days ago) Sunshine Health will return claims when billing information does not match the information that is currently in our files. or by e-mail at: Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. (1 days ago) Contact Us Florida Medicaid Sunshine Health. Requests are processed within 2-business days. If you are a non-contracted provider, you will be able to register after you submit your first claim. Florida acknowledged that the company's failures - blamed on technology glitches over nearly three months - were "non-willful." It is important that providers ensure Sunshine Health has accurate billing information on file. Farmington, MO 63640-3823 Do you need more information or have a question? Box based on date of service guidance below. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health Medicaid, Long Term Care, Serious Mental Illness: 1-866-796-0530 (TTY 1-800-955-8770) Ambetter from Sunshine Health Attn: Level II - Claim Dispute PO Box 5000 Farmington, MO 63640 -5000. 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. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. See Electronic Claims Submission for more information on how to initiate electronic claims/encounters. Providers may submit in writing, with all necessary documentation, including the EOP for consideration of additional reimbursement. WellCareMedicare products,claims and correspondence proceduresare not changing at this time. 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? Changes to a Providers Tax Identification Number and/or address are NOT acceptable when conveyed via a claim form. A Sunshine Health representative may contact you regarding your inquiry. The state is giving Sunshine 30 days to pay the fine. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. Register for OUD Training. In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines. We value our partnership and are here to help. Because protecting peoples' health is why we're here, and it's what we'll always do. Box 31370 Tampa, FL 33631-3370, WellCare Health Plans Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Providers must be registered with Florida Medicaid. Use the CPT-4 or billing codes found on the authorization or referral. This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. See if you're eligible to enroll. 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. Contact Provider Services, 8 a.m. to 8 p.m. Monday-Friday, at 1-844-477-8313 with questions or assistance with the following services: . For each subsequent inpatient hospital billing, the previous interim claim is voided by being recouped and replaced with the new claim type of bill code 0117. Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Sunshine Health for payment of covered services. The benefit information provided is a brief summary, not a complete description of benefits. If you have an , https://www.sunshinehealth.com/contact-us.html, Health (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. . transaction. Claims missing the requirements in bold will be returned,and a notice sent to the provider, creating payment delays. Contact Us Florida Medicaid Sunshine Health. (Just Now)Sunshine Health P.O. Contact Us Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. To download a claim disbute form, click here [PDF]. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. No other paid claims filed by the provider prior to the receipt of the claim under review. Fort Lauderdale, Florida. 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 in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. Sunshine health medicaid claims address Listing Websites about Sunshine Health Claims Mailing Address Filter Type:All Symptom Treatment Nutrition Contact Us Florida Medicaid Sunshine Health Health (6 days ago)Please fill out the below form or contact us at 1-866-796-0530 . 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. 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. If you must submit paper claims, you must mail to the appropriate payers P.O. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months . Date: In addition, it has the ability to generate an ASC X12N 835 electronic remittance advice known as an Explanation of Payment (EOP). 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~). 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. 08/31/21. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. Sunshine Health is a managed care plan with a Florida Medicaid contract. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Non-clean claims are submitted claims that require further investigation or development beyond the information contained therein. The benefit information provided is a brief summary, not a complete description of benefits. Sunshine Health uses an imaging process for claims retrieval. Pending or retroactive Enrollee eligibility. Please fill out the below form or contact us at 1-866-796-0530 . PO Box 4001 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. The websites below provide information to help providers find answers. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Limitations, co-payments and restrictions may apply. There are many ways to get in touch with us, and resources available on our website: Existing 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. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Always bill the primary diagnosis in the first field. To contact a Provider Services representative, call 1-844-477-8313. We have updated our process for prompt payment of claims. . 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. A Sunshine Health representative may contact you regarding your inquiry. Category: Health View Health Copies of claim forms will not be accepted. Contact Ambetter In Florida Ambetter from Sunshine Health. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Florida's largest Medicaid managed care plan paid a $9 million fine this week for failing to pay, or to timely pay, 121,227 claims from health care providers. For more information contact the Managed Care Plan. To ensure accurate and timely claims capture, please observe the following claims submission rules: A clean claim means a claim received by Sunshine Health for adjudication, in a nationally accepted format in compliance with standard coding guidelines and which requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by Sunshine Health. Limitations, co-payments and restrictions may apply. For more information on electronic filing . Your inquiry will be reviewed. For questions on medical or behavioral health authorizations, call 1-844-477-8313. Please review the guidance below and update your system accordingly. Attn: Appeals Department 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. 1-800-225-2573, extension 25525 Download the free version of Adobe Reader. Catastrophic event that substantially interferes with normal business operations of the provider or damage or destruction of the providers business office or records by a natural disaster. Your inquiry will be reviewed. Public notices florida. The Enrollee was eligible however the provider was unaware that the Enrollee was eligible for services at the time services were rendered. You will need Adobe Reader to open PDFs on this site. Medicaid fee schedule rate revisions shall be applied by Sunshine Health. Limitations, co-payments and restrictions may apply. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . 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. Health (Just Now) Florida Medicaid & Health Insurance Sunshine Health. 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) You will need Adobe Reader to open PDFs on this site. 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. For more information contact the Managed Care Plan. These plans require a referral to see specialists. Your inquiry will be reviewed. Sunshine Health Florida Claims Address Health (Just Now) (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . A Sunshine Health representative may contact you regarding your inquiry. 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. Register for FREE training to treat Opioid Use Disorder (OUD) and qualify for the waiver to prescribe buprenorphine. For more information contact the Managed Care Plan. 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. Ambetter Telehealth. 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. Get medical help from doctors via video and phone. A Sunshine Health , https://www.healthpoom.com/sunshine-health-claims-mailing-address/, Health (6 days ago) Ambetter Claims address and Phone Number - Lists Payer ID Claims Address Ambetter from Sunshine Health - Florida: 68069: 1301 International Parkway, Suite 400, , https://www.rcmguide.com/ambetter-claims-address-and-phone-number/, Health (1 days ago) Contact Ambetter In Florida Ambetter from Sunshine Health. All requests for claim reconsideration or adjustment must be received within 90 calendar days from the date of notification of payment or denial. Required fields are marked with an asterisk (*) See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Austin . (EOP). P.O. Your inquiry will be reviewed. . 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, Ancillary MMA/SMI/CW Including Home Health, PDN (PDF, Ancillary CMS Including Home Health, PDN (PDF), Ancillary LTC Including Home Health, PDN (PDF), Assisted Living Facility MMA/SMI/CW (PDF), Early Intervention Services Providers (PDF), PIC:TFK Partners in Care Together for Kids (PDF), PPEC Prescribed Pediatric Extended Care (PDF). 13,893* *As of 6/30/2022 Local Presence Pensacola, Tallahassee, Ocala, Jacksonville, New Port Richey, Tampa, Orlando, Fort Myers, West Palm Beach, Lauderhill, Miami Sunshine Health Sunshine Health is among the largest comprehensive healthcare plans in Florida. Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. 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. Sunshine Health's Payer ID is 68069. . 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. You will need Adobe Reader to open PDFs on this site. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. Box based on date of service guidance below. Claims will not be denied based solely on the period between date of service and the date of clean claim submission unless that period exceeds 365 days. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Failure to follow these instructions may result in eligibility rejections. EDIBA@centene.com. Box 31368 Tampa, FL 33631-3368. Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). Children's Medical Services Health Plan (CMS Health Plan) WellCare operates Children's Medical Services Health Plan on behalf of the Florida Department of Health, serving children and adolescents with special healthcare needs. Submit all claims/encounters with the proper provider NPI and /or Tax ID Number, Submit all claims/encounters with the Enrollees complete Medicaid number. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 , https://www.health-improve.org/sunshine-health-florida-claims-address/, Health (9 days ago) Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. and the UB04/837 facility claim forms. Agency for Health Care. Attn: LTC Reconsideration Stay up to date on any provider notices by bookmarking and reviewing Provider News. The benefit information provided is a brief summary, not a complete description of benefits. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . If you do not have an ID, sign up to obtain one today. For more information contact the . 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 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. Get covered with Sunshine Health today. 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. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service. If you must submit paper claims, you must mail to the appropriate payer's P.O. BOX 3070 If you are not already registered, create a new account by registering at payspanhealth.com/ or call 1-877-331-7154. Sunshine Health is a managed care plan with a Florida Medicaid contract. A Sunshine Health representative may contact you regarding your inquiry. The benefit information provided is a brief summary, not a complete description of benefits. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . P.O. For more information contact the Managed Care Plan. Ambetter Claims address and Phone Number - Lists Payer ID Claims Address . If billing a professional or an outpatient bill type institutional submission, please use the earliest from date in the claim submission as outlined below. Any prior underpayments will be reprocessed automatically. Date: 08/31/21. It was alleged that the experiment tripled the whooping cough infections in Florida to over one . Download the free version of Adobe Reader. Sunshine Health is a managed care plan with a Florida Medicaid contract. and attachments to the appropriate address: Ambetter from Sunshine Health Attn: Level I - Request for Reconsideration . You are required to submit an encounter or claim for each service that you render to a Sunshine Health Enrollee. Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. We have dedicated Provider Relations Representatives located in offices across Florida. For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539. P.O. Please submit this information on a W-9 form. 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. Ambetter can help. Sunshine Health is a managed care plan with a Florida Medicaid contract. For questions on specialty drugs, call 1-866-796-0530. Providers must submit, all claims and encounters within 180 days of the date of service, unless Sunshine Health or its vendors created the error. 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Healthcare is essential. Providers do not need to resubmit claims. WellCare Health Plans As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. (1 days ago) Sunshine Health will return claims when billing information does not match the information that is currently in our files. or by e-mail at: Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. (1 days ago) Contact Us Florida Medicaid Sunshine Health. Requests are processed within 2-business days. If you are a non-contracted provider, you will be able to register after you submit your first claim. Florida acknowledged that the company's failures - blamed on technology glitches over nearly three months - were "non-willful." It is important that providers ensure Sunshine Health has accurate billing information on file. Farmington, MO 63640-3823 Do you need more information or have a question? Box based on date of service guidance below. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health Medicaid, Long Term Care, Serious Mental Illness: 1-866-796-0530 (TTY 1-800-955-8770) Ambetter from Sunshine Health Attn: Level II - Claim Dispute PO Box 5000 Farmington, MO 63640 -5000. 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. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. See Electronic Claims Submission for more information on how to initiate electronic claims/encounters. Providers may submit in writing, with all necessary documentation, including the EOP for consideration of additional reimbursement. WellCareMedicare products,claims and correspondence proceduresare not changing at this time. 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? Changes to a Providers Tax Identification Number and/or address are NOT acceptable when conveyed via a claim form. A Sunshine Health representative may contact you regarding your inquiry. The state is giving Sunshine 30 days to pay the fine. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. Register for OUD Training. In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines. We value our partnership and are here to help. Because protecting peoples' health is why we're here, and it's what we'll always do. Box 31370 Tampa, FL 33631-3370, WellCare Health Plans Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Providers must be registered with Florida Medicaid. Use the CPT-4 or billing codes found on the authorization or referral. This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. See if you're eligible to enroll. 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. Contact Provider Services, 8 a.m. to 8 p.m. Monday-Friday, at 1-844-477-8313 with questions or assistance with the following services: . For each subsequent inpatient hospital billing, the previous interim claim is voided by being recouped and replaced with the new claim type of bill code 0117. Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Sunshine Health for payment of covered services. The benefit information provided is a brief summary, not a complete description of benefits. If you have an , https://www.sunshinehealth.com/contact-us.html, Health (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. . transaction. Claims missing the requirements in bold will be returned,and a notice sent to the provider, creating payment delays. Contact Us Florida Medicaid Sunshine Health. (Just Now)Sunshine Health P.O. Contact Us Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. To download a claim disbute form, click here [PDF]. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. No other paid claims filed by the provider prior to the receipt of the claim under review. Fort Lauderdale, Florida. 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 in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. Sunshine health medicaid claims address Listing Websites about Sunshine Health Claims Mailing Address Filter Type:All Symptom Treatment Nutrition Contact Us Florida Medicaid Sunshine Health Health (6 days ago)Please fill out the below form or contact us at 1-866-796-0530 . 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. 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. If you must submit paper claims, you must mail to the appropriate payers P.O. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months . Date: In addition, it has the ability to generate an ASC X12N 835 electronic remittance advice known as an Explanation of Payment (EOP). 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~). 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. 08/31/21. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. Sunshine Health is a managed care plan with a Florida Medicaid contract. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Non-clean claims are submitted claims that require further investigation or development beyond the information contained therein. The benefit information provided is a brief summary, not a complete description of benefits. Sunshine Health uses an imaging process for claims retrieval. Pending or retroactive Enrollee eligibility. Please fill out the below form or contact us at 1-866-796-0530 . PO Box 4001 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. The websites below provide information to help providers find answers. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Limitations, co-payments and restrictions may apply. There are many ways to get in touch with us, and resources available on our website: Existing 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. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Always bill the primary diagnosis in the first field. To contact a Provider Services representative, call 1-844-477-8313. We have updated our process for prompt payment of claims. . 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. A Sunshine Health representative may contact you regarding your inquiry. Category: Health View Health Copies of claim forms will not be accepted. Contact Ambetter In Florida Ambetter from Sunshine Health. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Florida's largest Medicaid managed care plan paid a $9 million fine this week for failing to pay, or to timely pay, 121,227 claims from health care providers. For more information contact the Managed Care Plan. To ensure accurate and timely claims capture, please observe the following claims submission rules: A clean claim means a claim received by Sunshine Health for adjudication, in a nationally accepted format in compliance with standard coding guidelines and which requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by Sunshine Health. Limitations, co-payments and restrictions may apply. For more information on electronic filing . Your inquiry will be reviewed. For questions on medical or behavioral health authorizations, call 1-844-477-8313. Please review the guidance below and update your system accordingly. Attn: Appeals Department 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. 1-800-225-2573, extension 25525 Download the free version of Adobe Reader. Catastrophic event that substantially interferes with normal business operations of the provider or damage or destruction of the providers business office or records by a natural disaster. Your inquiry will be reviewed. Public notices florida. The Enrollee was eligible however the provider was unaware that the Enrollee was eligible for services at the time services were rendered. You will need Adobe Reader to open PDFs on this site. Medicaid fee schedule rate revisions shall be applied by Sunshine Health. Limitations, co-payments and restrictions may apply. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . 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. Health (Just Now) Florida Medicaid & Health Insurance Sunshine Health. 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) You will need Adobe Reader to open PDFs on this site. 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. For more information contact the Managed Care Plan. These plans require a referral to see specialists. Your inquiry will be reviewed. Sunshine Health Florida Claims Address Health (Just Now) (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . A Sunshine Health representative may contact you regarding your inquiry. 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. Register for FREE training to treat Opioid Use Disorder (OUD) and qualify for the waiver to prescribe buprenorphine. For more information contact the Managed Care Plan. 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. Ambetter Telehealth. 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. Get medical help from doctors via video and phone. A Sunshine Health , https://www.healthpoom.com/sunshine-health-claims-mailing-address/, Health (6 days ago) Ambetter Claims address and Phone Number - Lists Payer ID Claims Address Ambetter from Sunshine Health - Florida: 68069: 1301 International Parkway, Suite 400, , https://www.rcmguide.com/ambetter-claims-address-and-phone-number/, Health (1 days ago) Contact Ambetter In Florida Ambetter from Sunshine Health. All requests for claim reconsideration or adjustment must be received within 90 calendar days from the date of notification of payment or denial. Required fields are marked with an asterisk (*) See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Austin . (EOP). P.O. Your inquiry will be reviewed. . 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, Ancillary MMA/SMI/CW Including Home Health, PDN (PDF, Ancillary CMS Including Home Health, PDN (PDF), Ancillary LTC Including Home Health, PDN (PDF), Assisted Living Facility MMA/SMI/CW (PDF), Early Intervention Services Providers (PDF), PIC:TFK Partners in Care Together for Kids (PDF), PPEC Prescribed Pediatric Extended Care (PDF). 13,893* *As of 6/30/2022 Local Presence Pensacola, Tallahassee, Ocala, Jacksonville, New Port Richey, Tampa, Orlando, Fort Myers, West Palm Beach, Lauderhill, Miami Sunshine Health Sunshine Health is among the largest comprehensive healthcare plans in Florida. Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. 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. Sunshine Health's Payer ID is 68069. . 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. You will need Adobe Reader to open PDFs on this site. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. Box based on date of service guidance below. Claims will not be denied based solely on the period between date of service and the date of clean claim submission unless that period exceeds 365 days. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Failure to follow these instructions may result in eligibility rejections. EDIBA@centene.com. Box 31368 Tampa, FL 33631-3368. Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). Children's Medical Services Health Plan (CMS Health Plan) WellCare operates Children's Medical Services Health Plan on behalf of the Florida Department of Health, serving children and adolescents with special healthcare needs. Submit all claims/encounters with the proper provider NPI and /or Tax ID Number, Submit all claims/encounters with the Enrollees complete Medicaid number. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 , https://www.health-improve.org/sunshine-health-florida-claims-address/, Health (9 days ago) Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. and the UB04/837 facility claim forms. Agency for Health Care. Attn: LTC Reconsideration Stay up to date on any provider notices by bookmarking and reviewing Provider News. The benefit information provided is a brief summary, not a complete description of benefits. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . If you do not have an ID, sign up to obtain one today. For more information contact the . 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 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. Get covered with Sunshine Health today. 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. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service. If you must submit paper claims, you must mail to the appropriate payer's P.O. BOX 3070 If you are not already registered, create a new account by registering at payspanhealth.com/ or call 1-877-331-7154. Sunshine Health is a managed care plan with a Florida Medicaid contract. A Sunshine Health representative may contact you regarding your inquiry. The benefit information provided is a brief summary, not a complete description of benefits. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . P.O. For more information contact the Managed Care Plan. Ambetter Claims address and Phone Number - Lists Payer ID Claims Address . If billing a professional or an outpatient bill type institutional submission, please use the earliest from date in the claim submission as outlined below. Any prior underpayments will be reprocessed automatically. Date: 08/31/21. It was alleged that the experiment tripled the whooping cough infections in Florida to over one . Download the free version of Adobe Reader. Sunshine Health is a managed care plan with a Florida Medicaid contract. and attachments to the appropriate address: Ambetter from Sunshine Health Attn: Level I - Request for Reconsideration . You are required to submit an encounter or claim for each service that you render to a Sunshine Health Enrollee. Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. We have dedicated Provider Relations Representatives located in offices across Florida. For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539. P.O. Please submit this information on a W-9 form. 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. Ambetter can help. Sunshine Health is a managed care plan with a Florida Medicaid contract. For questions on specialty drugs, call 1-866-796-0530. Providers must submit, all claims and encounters within 180 days of the date of service, unless Sunshine Health or its vendors created the error. 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Healthcare is essential. Providers do not need to resubmit claims. WellCare Health Plans As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. (1 days ago) Sunshine Health will return claims when billing information does not match the information that is currently in our files. or by e-mail at: Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. (1 days ago) Contact Us Florida Medicaid Sunshine Health. Requests are processed within 2-business days. If you are a non-contracted provider, you will be able to register after you submit your first claim. Florida acknowledged that the company's failures - blamed on technology glitches over nearly three months - were "non-willful." It is important that providers ensure Sunshine Health has accurate billing information on file. Farmington, MO 63640-3823 Do you need more information or have a question? Box based on date of service guidance below. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health Medicaid, Long Term Care, Serious Mental Illness: 1-866-796-0530 (TTY 1-800-955-8770) Ambetter from Sunshine Health Attn: Level II - Claim Dispute PO Box 5000 Farmington, MO 63640 -5000. 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. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. See Electronic Claims Submission for more information on how to initiate electronic claims/encounters. Providers may submit in writing, with all necessary documentation, including the EOP for consideration of additional reimbursement. WellCareMedicare products,claims and correspondence proceduresare not changing at this time. 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? Changes to a Providers Tax Identification Number and/or address are NOT acceptable when conveyed via a claim form. A Sunshine Health representative may contact you regarding your inquiry. The state is giving Sunshine 30 days to pay the fine. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. Register for OUD Training. In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines. We value our partnership and are here to help. Because protecting peoples' health is why we're here, and it's what we'll always do. Box 31370 Tampa, FL 33631-3370, WellCare Health Plans Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Providers must be registered with Florida Medicaid. Use the CPT-4 or billing codes found on the authorization or referral. This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. See if you're eligible to enroll. 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. Contact Provider Services, 8 a.m. to 8 p.m. Monday-Friday, at 1-844-477-8313 with questions or assistance with the following services: . For each subsequent inpatient hospital billing, the previous interim claim is voided by being recouped and replaced with the new claim type of bill code 0117. Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Sunshine Health for payment of covered services. The benefit information provided is a brief summary, not a complete description of benefits. If you have an , https://www.sunshinehealth.com/contact-us.html, Health (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. . transaction. Claims missing the requirements in bold will be returned,and a notice sent to the provider, creating payment delays. Contact Us Florida Medicaid Sunshine Health. (Just Now)Sunshine Health P.O. Contact Us Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. To download a claim disbute form, click here [PDF]. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. No other paid claims filed by the provider prior to the receipt of the claim under review. Fort Lauderdale, Florida. 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 in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. Sunshine health medicaid claims address Listing Websites about Sunshine Health Claims Mailing Address Filter Type:All Symptom Treatment Nutrition Contact Us Florida Medicaid Sunshine Health Health (6 days ago)Please fill out the below form or contact us at 1-866-796-0530 . 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. 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. If you must submit paper claims, you must mail to the appropriate payers P.O. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months . Date: In addition, it has the ability to generate an ASC X12N 835 electronic remittance advice known as an Explanation of Payment (EOP). 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~). 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. 08/31/21. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. Sunshine Health is a managed care plan with a Florida Medicaid contract. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Non-clean claims are submitted claims that require further investigation or development beyond the information contained therein. The benefit information provided is a brief summary, not a complete description of benefits. Sunshine Health uses an imaging process for claims retrieval. Pending or retroactive Enrollee eligibility. Please fill out the below form or contact us at 1-866-796-0530 . PO Box 4001 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. The websites below provide information to help providers find answers. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Limitations, co-payments and restrictions may apply. There are many ways to get in touch with us, and resources available on our website: Existing 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. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Always bill the primary diagnosis in the first field. To contact a Provider Services representative, call 1-844-477-8313. We have updated our process for prompt payment of claims. . 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. A Sunshine Health representative may contact you regarding your inquiry. Category: Health View Health Copies of claim forms will not be accepted. Contact Ambetter In Florida Ambetter from Sunshine Health. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Florida's largest Medicaid managed care plan paid a $9 million fine this week for failing to pay, or to timely pay, 121,227 claims from health care providers. For more information contact the Managed Care Plan. To ensure accurate and timely claims capture, please observe the following claims submission rules: A clean claim means a claim received by Sunshine Health for adjudication, in a nationally accepted format in compliance with standard coding guidelines and which requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by Sunshine Health. Limitations, co-payments and restrictions may apply. For more information on electronic filing . Your inquiry will be reviewed. For questions on medical or behavioral health authorizations, call 1-844-477-8313. Please review the guidance below and update your system accordingly. Attn: Appeals Department 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. 1-800-225-2573, extension 25525 Download the free version of Adobe Reader. Catastrophic event that substantially interferes with normal business operations of the provider or damage or destruction of the providers business office or records by a natural disaster. Your inquiry will be reviewed. Public notices florida. The Enrollee was eligible however the provider was unaware that the Enrollee was eligible for services at the time services were rendered. You will need Adobe Reader to open PDFs on this site. Medicaid fee schedule rate revisions shall be applied by Sunshine Health. Limitations, co-payments and restrictions may apply. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . 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. Health (Just Now) Florida Medicaid & Health Insurance Sunshine Health. 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) You will need Adobe Reader to open PDFs on this site. 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. For more information contact the Managed Care Plan. These plans require a referral to see specialists. Your inquiry will be reviewed. Sunshine Health Florida Claims Address Health (Just Now) (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . A Sunshine Health representative may contact you regarding your inquiry. 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. Register for FREE training to treat Opioid Use Disorder (OUD) and qualify for the waiver to prescribe buprenorphine. For more information contact the Managed Care Plan. 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. Ambetter Telehealth. 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. Get medical help from doctors via video and phone. A Sunshine Health , https://www.healthpoom.com/sunshine-health-claims-mailing-address/, Health (6 days ago) Ambetter Claims address and Phone Number - Lists Payer ID Claims Address Ambetter from Sunshine Health - Florida: 68069: 1301 International Parkway, Suite 400, , https://www.rcmguide.com/ambetter-claims-address-and-phone-number/, Health (1 days ago) Contact Ambetter In Florida Ambetter from Sunshine Health. All requests for claim reconsideration or adjustment must be received within 90 calendar days from the date of notification of payment or denial. Required fields are marked with an asterisk (*) See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Austin . (EOP). P.O. Your inquiry will be reviewed. . 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, Ancillary MMA/SMI/CW Including Home Health, PDN (PDF, Ancillary CMS Including Home Health, PDN (PDF), Ancillary LTC Including Home Health, PDN (PDF), Assisted Living Facility MMA/SMI/CW (PDF), Early Intervention Services Providers (PDF), PIC:TFK Partners in Care Together for Kids (PDF), PPEC Prescribed Pediatric Extended Care (PDF). 13,893* *As of 6/30/2022 Local Presence Pensacola, Tallahassee, Ocala, Jacksonville, New Port Richey, Tampa, Orlando, Fort Myers, West Palm Beach, Lauderhill, Miami Sunshine Health Sunshine Health is among the largest comprehensive healthcare plans in Florida. Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. 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. Sunshine Health's Payer ID is 68069. . 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. You will need Adobe Reader to open PDFs on this site. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. Box based on date of service guidance below. Claims will not be denied based solely on the period between date of service and the date of clean claim submission unless that period exceeds 365 days. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Failure to follow these instructions may result in eligibility rejections. EDIBA@centene.com. Box 31368 Tampa, FL 33631-3368. Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). Children's Medical Services Health Plan (CMS Health Plan) WellCare operates Children's Medical Services Health Plan on behalf of the Florida Department of Health, serving children and adolescents with special healthcare needs. Submit all claims/encounters with the proper provider NPI and /or Tax ID Number, Submit all claims/encounters with the Enrollees complete Medicaid number. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 , https://www.health-improve.org/sunshine-health-florida-claims-address/, Health (9 days ago) Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. and the UB04/837 facility claim forms. Agency for Health Care. Attn: LTC Reconsideration Stay up to date on any provider notices by bookmarking and reviewing Provider News. The benefit information provided is a brief summary, not a complete description of benefits. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . If you do not have an ID, sign up to obtain one today. For more information contact the . 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 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. Get covered with Sunshine Health today. 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. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service. If you must submit paper claims, you must mail to the appropriate payer's P.O. BOX 3070 If you are not already registered, create a new account by registering at payspanhealth.com/ or call 1-877-331-7154. Sunshine Health is a managed care plan with a Florida Medicaid contract. A Sunshine Health representative may contact you regarding your inquiry. The benefit information provided is a brief summary, not a complete description of benefits. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . P.O. For more information contact the Managed Care Plan. Ambetter Claims address and Phone Number - Lists Payer ID Claims Address . If billing a professional or an outpatient bill type institutional submission, please use the earliest from date in the claim submission as outlined below. Any prior underpayments will be reprocessed automatically. Date: 08/31/21. It was alleged that the experiment tripled the whooping cough infections in Florida to over one . Download the free version of Adobe Reader. Sunshine Health is a managed care plan with a Florida Medicaid contract. and attachments to the appropriate address: Ambetter from Sunshine Health Attn: Level I - Request for Reconsideration . You are required to submit an encounter or claim for each service that you render to a Sunshine Health Enrollee. Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. We have dedicated Provider Relations Representatives located in offices across Florida. For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539. P.O. Please submit this information on a W-9 form. 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. Ambetter can help. Sunshine Health is a managed care plan with a Florida Medicaid contract. For questions on specialty drugs, call 1-866-796-0530. Providers must submit, all claims and encounters within 180 days of the date of service, unless Sunshine Health or its vendors created the error. 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Healthcare is essential. Providers do not need to resubmit claims. WellCare Health Plans As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. (1 days ago) Sunshine Health will return claims when billing information does not match the information that is currently in our files. or by e-mail at: Our Town Hall series is ongoing; however, we modified our existing process to separate the sessions and make them more specific to specialty types. (1 days ago) Contact Us Florida Medicaid Sunshine Health. Requests are processed within 2-business days. If you are a non-contracted provider, you will be able to register after you submit your first claim. Florida acknowledged that the company's failures - blamed on technology glitches over nearly three months - were "non-willful." It is important that providers ensure Sunshine Health has accurate billing information on file. Farmington, MO 63640-3823 Do you need more information or have a question? Box based on date of service guidance below. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health Medicaid, Long Term Care, Serious Mental Illness: 1-866-796-0530 (TTY 1-800-955-8770) Ambetter from Sunshine Health Attn: Level II - Claim Dispute PO Box 5000 Farmington, MO 63640 -5000. 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. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters. See Electronic Claims Submission for more information on how to initiate electronic claims/encounters. Providers may submit in writing, with all necessary documentation, including the EOP for consideration of additional reimbursement. WellCareMedicare products,claims and correspondence proceduresare not changing at this time. 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? Changes to a Providers Tax Identification Number and/or address are NOT acceptable when conveyed via a claim form. A Sunshine Health representative may contact you regarding your inquiry. The state is giving Sunshine 30 days to pay the fine. The provider can substantiate that a claim was filed within 180 days of discovering Medicaid Plan eligibility. Register for OUD Training. In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines. We value our partnership and are here to help. Because protecting peoples' health is why we're here, and it's what we'll always do. Box 31370 Tampa, FL 33631-3370, WellCare Health Plans Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. Providers must be registered with Florida Medicaid. Use the CPT-4 or billing codes found on the authorization or referral. This integration allows providers to access medical and behavioral health services in one place and have a single point of contact and benefits administration. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. See if you're eligible to enroll. 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. Contact Provider Services, 8 a.m. to 8 p.m. Monday-Friday, at 1-844-477-8313 with questions or assistance with the following services: . For each subsequent inpatient hospital billing, the previous interim claim is voided by being recouped and replaced with the new claim type of bill code 0117. Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Sunshine Health for payment of covered services. The benefit information provided is a brief summary, not a complete description of benefits. If you have an , https://www.sunshinehealth.com/contact-us.html, Health (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. . transaction. Claims missing the requirements in bold will be returned,and a notice sent to the provider, creating payment delays. Contact Us Florida Medicaid Sunshine Health. (Just Now)Sunshine Health P.O. Contact Us Call Provider Services at1-844-477-8313 Monday through Friday from 8 a.m. to 8 p.m. Eastern or submit a request form. To download a claim disbute form, click here [PDF]. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health Insurance Marketplace product, Ambetter. No other paid claims filed by the provider prior to the receipt of the claim under review. Fort Lauderdale, Florida. 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 in 2018-2020 will be paid at the applicable 2018 MediKids feeschedule or MPIP rate. Sunshine health medicaid claims address Listing Websites about Sunshine Health Claims Mailing Address Filter Type:All Symptom Treatment Nutrition Contact Us Florida Medicaid Sunshine Health Health (6 days ago)Please fill out the below form or contact us at 1-866-796-0530 . 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. 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. If you must submit paper claims, you must mail to the appropriate payers P.O. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months . Date: In addition, it has the ability to generate an ASC X12N 835 electronic remittance advice known as an Explanation of Payment (EOP). 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~). 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. 08/31/21. In order to avoid rejected claims or encounters always remember to: You will need Adobe Reader to open PDFs on this site. Sunshine Health is a managed care plan with a Florida Medicaid contract. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Non-clean claims are submitted claims that require further investigation or development beyond the information contained therein. The benefit information provided is a brief summary, not a complete description of benefits. Sunshine Health uses an imaging process for claims retrieval. Pending or retroactive Enrollee eligibility. Please fill out the below form or contact us at 1-866-796-0530 . PO Box 4001 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. The websites below provide information to help providers find answers. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Limitations, co-payments and restrictions may apply. There are many ways to get in touch with us, and resources available on our website: Existing 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. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Staywell Health Plans, Children's Medical Services Health Plans, Sunshine Health Plan, Childrens Medical Services Health Plan - Operated by Sunshine Health. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Always bill the primary diagnosis in the first field. To contact a Provider Services representative, call 1-844-477-8313. We have updated our process for prompt payment of claims. . 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. A Sunshine Health representative may contact you regarding your inquiry. Category: Health View Health Copies of claim forms will not be accepted. Contact Ambetter In Florida Ambetter from Sunshine Health. Electronic claim submission (EDI) is the preferred method for fast and accurate processing. Florida's largest Medicaid managed care plan paid a $9 million fine this week for failing to pay, or to timely pay, 121,227 claims from health care providers. For more information contact the Managed Care Plan. To ensure accurate and timely claims capture, please observe the following claims submission rules: A clean claim means a claim received by Sunshine Health for adjudication, in a nationally accepted format in compliance with standard coding guidelines and which requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by Sunshine Health. Limitations, co-payments and restrictions may apply. For more information on electronic filing . Your inquiry will be reviewed. For questions on medical or behavioral health authorizations, call 1-844-477-8313. Please review the guidance below and update your system accordingly. Attn: Appeals Department 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. 1-800-225-2573, extension 25525 Download the free version of Adobe Reader. Catastrophic event that substantially interferes with normal business operations of the provider or damage or destruction of the providers business office or records by a natural disaster. Your inquiry will be reviewed. Public notices florida. The Enrollee was eligible however the provider was unaware that the Enrollee was eligible for services at the time services were rendered. You will need Adobe Reader to open PDFs on this site. Medicaid fee schedule rate revisions shall be applied by Sunshine Health. Limitations, co-payments and restrictions may apply. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . 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. Health (Just Now) Florida Medicaid & Health Insurance Sunshine Health. 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) You will need Adobe Reader to open PDFs on this site. 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. For more information contact the Managed Care Plan. These plans require a referral to see specialists. Your inquiry will be reviewed. Sunshine Health Florida Claims Address Health (Just Now) (Just Now) Sunshine Health P.O. Your inquiry will be reviewed. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . A Sunshine Health representative may contact you regarding your inquiry. 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. Register for FREE training to treat Opioid Use Disorder (OUD) and qualify for the waiver to prescribe buprenorphine. For more information contact the Managed Care Plan. 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. Ambetter Telehealth. 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. Get medical help from doctors via video and phone. A Sunshine Health , https://www.healthpoom.com/sunshine-health-claims-mailing-address/, Health (6 days ago) Ambetter Claims address and Phone Number - Lists Payer ID Claims Address Ambetter from Sunshine Health - Florida: 68069: 1301 International Parkway, Suite 400, , https://www.rcmguide.com/ambetter-claims-address-and-phone-number/, Health (1 days ago) Contact Ambetter In Florida Ambetter from Sunshine Health. All requests for claim reconsideration or adjustment must be received within 90 calendar days from the date of notification of payment or denial. Required fields are marked with an asterisk (*) See the Appointment Availability standards for Medicaid, Children's Medical Services Health Plan, Ambetter (Marketplace) and Wellcare (Medicare). Austin . (EOP). P.O. Your inquiry will be reviewed. . 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, Ancillary MMA/SMI/CW Including Home Health, PDN (PDF, Ancillary CMS Including Home Health, PDN (PDF), Ancillary LTC Including Home Health, PDN (PDF), Assisted Living Facility MMA/SMI/CW (PDF), Early Intervention Services Providers (PDF), PIC:TFK Partners in Care Together for Kids (PDF), PPEC Prescribed Pediatric Extended Care (PDF). 13,893* *As of 6/30/2022 Local Presence Pensacola, Tallahassee, Ocala, Jacksonville, New Port Richey, Tampa, Orlando, Fort Myers, West Palm Beach, Lauderhill, Miami Sunshine Health Sunshine Health is among the largest comprehensive healthcare plans in Florida. Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. 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. Sunshine Health's Payer ID is 68069. . 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. You will need Adobe Reader to open PDFs on this site. New inpatient hospital claims require the initial date of admission, dates of service and amounts from previous claims through the current billing. Box based on date of service guidance below. Claims will not be denied based solely on the period between date of service and the date of clean claim submission unless that period exceeds 365 days. Health (1 days ago) You can also reach us from 8am-8pm EST at 1-877-687-1169 ( Relay Florida 1-800-955-8770 ). Failure to follow these instructions may result in eligibility rejections. EDIBA@centene.com. Box 31368 Tampa, FL 33631-3368. Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). Children's Medical Services Health Plan (CMS Health Plan) WellCare operates Children's Medical Services Health Plan on behalf of the Florida Department of Health, serving children and adolescents with special healthcare needs. Submit all claims/encounters with the proper provider NPI and /or Tax ID Number, Submit all claims/encounters with the Enrollees complete Medicaid number. Box 459089 Fort Lauderdale, FL 33345-9089 Phone: 1-866-796-0530 TTY: 1-800-955-8770 Monday-Friday 8 , https://www.health-improve.org/sunshine-health-florida-claims-address/, Health (9 days ago) Sunshine Health Florida Claims Address Health (Just Now) Billing and Claims Sunshine Health Health (Just Now) Sunshine Health P.O. and the UB04/837 facility claim forms. Agency for Health Care. Attn: LTC Reconsideration Stay up to date on any provider notices by bookmarking and reviewing Provider News. The benefit information provided is a brief summary, not a complete description of benefits. Health 6 hours ago Please fill out the below form or contact us at 1-866-796-0530 . If you do not have an ID, sign up to obtain one today. For more information contact the . 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 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. Get covered with Sunshine Health today. 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. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service. If you must submit paper claims, you must mail to the appropriate payer's P.O. BOX 3070 If you are not already registered, create a new account by registering at payspanhealth.com/ or call 1-877-331-7154. Sunshine Health is a managed care plan with a Florida Medicaid contract. A Sunshine Health representative may contact you regarding your inquiry. The benefit information provided is a brief summary, not a complete description of benefits. Health (6 days ago) Please fill out the below form or contact us at 1-866-796-0530 . P.O. For more information contact the Managed Care Plan. Ambetter Claims address and Phone Number - Lists Payer ID Claims Address . If billing a professional or an outpatient bill type institutional submission, please use the earliest from date in the claim submission as outlined below. Any prior underpayments will be reprocessed automatically. Date: 08/31/21. It was alleged that the experiment tripled the whooping cough infections in Florida to over one . Download the free version of Adobe Reader. Sunshine Health is a managed care plan with a Florida Medicaid contract. and attachments to the appropriate address: Ambetter from Sunshine Health Attn: Level I - Request for Reconsideration . You are required to submit an encounter or claim for each service that you render to a Sunshine Health Enrollee. Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. We have dedicated Provider Relations Representatives located in offices across Florida. For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539. P.O. Please submit this information on a W-9 form. 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. Ambetter can help. Sunshine Health is a managed care plan with a Florida Medicaid contract. For questions on specialty drugs, call 1-866-796-0530. Providers must submit, all claims and encounters within 180 days of the date of service, unless Sunshine Health or its vendors created the error. 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