![]() ![]() Then contact Sunshine Health at 1-84 to update your address in our systems. If needed, please update to the correct address. ![]() Where should I go to update my PaySpan account? Contact one of these trading partners to use our electronic transaction options. Where can providers find Sunshine Health’s clearinghouse partners?Īll clearinghouse partners currently active with Sunshine Health are listed under Electronic Transactions. Providers can also submit a corrected claim through any of the acceptable EDI clearinghouses. Guidelines for Proper Claims Submissions Can providers submit corrected claims via the Sunshine Health Secure Provider Portal? Where can providers reference Sunshine Health’s claim submission and EDI guidelines? Yes, any group/office staff members can attend the training. Providers are encouraged to review the Provider Manual for specific plan-required trainings at Manuals, Forms and Resources.Īre office managers/administrators able to attend trainings on behalf of the provider? Please visit Provider Training to get started.Options for initial and ongoing training include live sessions, instructor-led sessions, specialized webinars, and/or self-paced trainings through Relias Learning, an online learning management system.Where can providers locate and complete trainings (including required New Provider Orientation and Compliance trainings)? Providers can visit the Sunshine Health Secure Provider Portal to review member benefit information, submit authorizations and claims as well as file claims disputes. Where can providers access the secure Sunshine Health Secure Provider Portal? Sunshine Health offers many convenient and secure tools to assist providers. You can also call Sunshine Health Provider Services at 1-84. Mobile crisis assessment and interventionįor questions or concerns, please contact your Provider Engagement Administrator.The services listed below do not require prior authorization: Applied Behavior Analysis (ABA) – Title 21.Behavioral Health Residential outpatient treatment.Dental or oral surgical procedures requiring general anesthesia.Intensive Outpatient Program for Substance Use Disorder.Injectable drugs and drugs given by an MD in office setting, IV infusion.Intensive outpatient therapy Mental Health.Family training and counseling for child development.Implantable devices (cochlear implants).Procedures done in outpatient setting, ambulatory surgical center or office.Select Behavioral Health Community - based services.Non-medical NEMT transport for CW members.SIPP (Statewide Inpatient Psychiatric Program).Inpatient facility admissions, inpatient hospice, detox, SNF and Other Post-Acute Care Services.The services listed below require a prior authorization: The health plan suggests utilizing the prior authorization check tool on our website to verify if an authorization is required: Any deviations by product are noted below. The information below applies to our Medicaid (Sunshine Health and Staywell Medicaid and Long Term Care), Child Welfare Specialty Plan, Serious Mental Illness Plan and Children’s Medical Services Health Plan products. ![]() The notification is to advise you that at this time, the plans are aligned on which services do and do not require a prior authorization and there are no significant changes. The goal of our combined company is to ensure the highest quality care for our members in partnership with our providers. As part of our ongoing integration efforts to combine the best of both Sunshine Health and WellCare health plans, we have reviewed policies and processes regarding prior authorization. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |