Necesitar Adobe Reader para abrir archivos PDF en este sitio. Follow Us. Some providers may not perform certain services based on religious or moral beliefs. Children's Medical Services Health Plan Operated by Sunshine Health is a plan for children and youth less than 21 years old with serious, chronic conditions. O. Sunshine Health es un plan de cuidado administrado con un contrato con Florida Medicaid. Find a Provider Sunshine Health offers electronic provider directories based on your plan. All appointment times are guaranteed by our Sunshine Health Psychiatrists & Providers. A referral from a members PCP is needed for care beyond their PCPs scope, such as seeing a specialist. Learn More. Obtenga seguro Obtenga ms informacin sobre la cobertura de salud que proporcionamos y sobre lo que usted puede obtener segn su elegibilidad. Find health tips, financial advice and more to build a healthier life. Thank you, Sunshine, you are a true blessing. Pre-Auth Tool | Ambetter from Sunshine Health This service requires prior authorization. Its almost like a document from litigation, and were not in litigation. Medicaid Provider Search Child Welfare Provider Search Long Term Care Provider Search Some areas of campus may have additional policies in place, so please call the appropriate location for current COVID-19 precautions. Cloud. Florida Behavioral health functions are transitioning from Cenpatico (a subsidiary of Envolve PeopleCare) to Sunshine Health. Some providers may not perform certain services based on religious or moral beliefs. Portal para socios Cree su propia cuenta en lnea hoy mismo! Vision and dental buy ups are not available within this plan. Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Florida - Envolve Vision I called them back and I said, Im not signing this. We believe that delivering quality care doesnt have to be complicated. Floridas largest Medicaid managed care vendor, which came under scrutiny for failing to pay claims for sick children over several months, is being fined a record $9 million by the Agency for Health Care Administration (AHCA). Use your ZIP Code to find your personal plan. However, this does NOT guarantee payment. Find everything you need in the member online account. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Provider Resources, Manuals & Forms - Ambetter from Sunshine Health Learn more! The following essential providers are part of Sunshine Health's network and are available to all members: Johns Hopkins All Children's Hospital Nemours Children's Hospital Nicklaus Children's Hospital Wolfson's Children's Hospital Florida International University Dental services need to be verified by Envolve Dental. As her vision became a reality, generations of our family joined the mission of enriching the lives of people who have advanced in years or who need assistance due to illness, injury, or medical condition. Sunshine must also show that the claims processing systems work for at least a 30-day period. Portal de atencin de Sunshine Health para socios | Inicio de sesin Plan de Salud de Servicios Mdicos para Nios Get medical help from doctors via video and phone. Forms - Ambetter from Sunshine Health Dental services need to be verified byEnvolve Dental Provider Services for Medicaid 866-921-6769 Members: call the number on the back of your ID card or go to the plan site. Find Sunshine Health Cardiologists & Providers with verified reviews. Healthcare is essential. Sunshine Health Provider Portal & Resources | Sunshine Health Need help? Se abrir una nueva ventana. Find and enroll in a plan that's right for you. Ambetter from Sunshine Health Adds Hardee County in Florida to 2023 All rights reserved. Florida Politics is a statewide, new media platform covering campaigns, elections, government, policy, and lobbying in Florida. A flu shot is the best way to protect yourself and those close to you from the flu. Box 1459Tallahassee, Florida 32301(850) 224-3907info@fhca.org, 2023 Florida Health Care Association. 99206 Contact Us | Florida Medicaid | Sunshine Health Referrals are not required for OB/GYN, mental health/substance abuse disorder, urgent care or emergent care. So, to make working with us easier, we developed the Ambetter Provider Toolkit. Cloud. Complex imaging, MRA, MRI, PET, and CT Scans need to be verified byNIA You will need Adobe Reader to open PDFs on this site. A carousel is a rotating set of images, rotation stops on keyboard focus on carousel tab controls or hovering the mouse pointer over images. Thats 40% of the 121,227 unpaid claims. Every provider that appears in search is open to new patients. Best Sunshine Health Psychiatrists Near Me | Zocdoc We expanded our plans in 2023 to help members find more coverage options. Relay Florida 1-800-955-8770. Provider Quick Reference Guide. Find info and tools you can use to build a healthier life. Right Here. So, to make working with us easier, we developed the Ambetter Provider Toolkit. Healthcare designed for you. See coverage in your area; Find doctors and hospitals; View pharmacy program benefits; View essential health benefits; Find and enroll in a plan that's right for you. Our comprehensive services include short and long-term rehabilitation (PT / OT / and speech therapy), enhanced assisted living,adult family homes,mental health, memory care,and Medicare-certified home health . It's quick and easy. Sign up now! Brendan Ramirez, CEO of Pan American Behavioral Health Services LLC in Orlando, said it took months to negotiate with Sunshine to receive payments his organization was entitled to. For Providers For Brokers Sunshine Health Get to Know Your Dental Coverage Good dental health is important to your overall health. Sunshine Healths campus in Spokane Valley offers in-patient, outpatient, and residential services. Medicaid, health insurance, workers compensation, and business and professional regulation are just a few of the things that keep me busy. Find a Doctor or Pharmacy - Wellcare All rights reserved. With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. Affordable Health Insurance in Florida | Ambetter from Sunshine Health Use the tabs or the previous and next buttons to change the displayed slide. Please see important information on Hurricanes Ian and Nicole. Find and enroll in a plan that's right for you. Coronavirus Information Pre-Auth Check Use our tool to see if a pre-authorization is needed. This platform and all of its content are owned by Extensive Enterprises Media. If you need help with other needs, like transportation or community resources, call us at 1-352-840-1102. Gov. Download the free version of Adobe Reader. The SHFI team includes LPNs, RNs, home health aides, medical social workers, mental health professionals, rehabilitative therapists, and support staff who provide attentive and loving care on our Spokane Valley campus. Pre-Auth Check Tool - Ambetter | Medicaid & Child Welfare| Medicare| Healthy Kids. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. Health Insurance Resources for Providers - Ambetter from Sunshine Health Find a Doctor | Florida Medicaid | Sunshine Health Im pleased that everybody is so nice and it is genuine. It's designed to provide you with valuable education and materials to simplify your administrative responsibilitiesso you can focus on providing care. Plan de Salud de Children's Medical Services, Cmo crear nuevos hbitos positivos en nuestro nuevo mundo, Servicios de embarazo y para recin nacidos, Descargo de responsabilidad de beneficios de Medicaid, Reclamaciones, agravios y apelaciones del plan, Obtenga el mayor beneficio de su cobertura, Derechos y responsabilidades de los socios, Programa contra el fraude, malgasto y abuso, Herramientas de planificacin y educacin, Derechos y responsabilidades de los miembros, Plan de salud de servicios mdicos para nios (KidCare), Reclamaciones, quejas y apelaciones (Medicaid), Derechos y responsabilidades de los afiliados. 2023 Sunshine Health Facilities. If you are interested in joining our network call toll free 1-866-595-8116 or to request a contract use our Contract Request Form or email us at SunshineContracting@Centene.com. Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix ; Fax 877-250-5290. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. It is not clear how long the corrective action plan will be in effect, but it wont be lifted for at least one month. My Health Pays Rewards Ways to Save; What is Ambetter? Use our tool to see if a pre-authorization is needed. Note:Services related to an authorization denial will result in denial of all associated claims. Pre-Auth Check Tool - Ambetter | Medicaid & Child Welfare | Medicare | Healthy Kids Make an appointment online instantly with Cardiologists that accept Sunshine Health insurance. Sunshine Health Plan is the largest Medicaid managed care plan in the state. All visitors must wear a mask when entering any of our facilities. View our Preferred Drug List to see what drugs are covered. Im just trying to get money that you guys owe me.. Limitations, co-payments and restrictions may apply. You can find your Provider Engagement Administrator by selecting the county of the primary office for your organization. Please note that a new browser window will open. If you need help, call Provider Services at 1-877-687-1169 (Relay Florida 1-800-955-8770) Monday through Friday from 8 a.m. to 8 p.m. Eastern. All rights reserved. Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA. Privacy Policy, Quality Assurance and Performance Improvement (QAPI), Life Safety and Emergency Management Summit, AHCA/NCAL Five Star Quality Rating System. Florida Medicaid hits Sunshine Health with $9M sanction for not paying providers claims, Tallahassee to add more than 100 cameras to traffic management system, Anna Eskamani, Carlos Guillermo Smith say HB 1557 will endanger teens, Rickey Mitchell leads June fundraising race for Miami-Dade Sheriff with $200K self-donation, Ukraine to NATO? Sunshine Health - Florida Medicaid, planes de Medicare, mercado de If you live there, you may refill your prescription medications early. Best Sunshine Health Eye Doctors Near Me | Zocdoc Its a goal we continue to achieve today., Dr. All attempts are made to provide the most current information on the Pre-Auth Needed Tool. With Ambetter from Sunshine Health it's easy to take charge of your health. If you need additional help or need to create an account, please email membership@fhca.org, Forgot your password? Secure Provider Website Registration (PDF), Ambetter Provider Orientation Training webinars, Outpatient Prior Authorization Form (PDF), Prior Authorization Request Form for Non-Specialty Drugs (PDF), Prior Authorization Request Form for Specialty Medication (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Intensive Outpatient/Day Treatment Form (PDF), Psychological or Neuropsych Testing Authorization Request Form (PDF), No Surprises Act Open Negotiation Form (PDF), Child and Adolescent Well Care Visits (WCV) (PDF), Appropriate Treatment for Upper Respiratory Infection (URI) (PDF), Appropriate Testing for Pharyngitis (CWP) (PDF), Use of Imaging Studies for Low Back Pain (PDF), Best Practices for Prescribing Opioids (PDF), Referral Form Fraud, Waste, and Abuse (PDF). Healthcare is essential. Use Zocdoc to find eye doctors near you who take Sunshine Health insurance. WA Sunshine Health does not accept responsibility or liability for any loss or damage arising from the use of email. Twitter:@PeterSchorschFL I appreciate that. Sunshine Health Provider Resources | Florida Health Care Association Non-starter for Ron DeSantis, Ron DeSantis repeats claim that he brought pride to Florida by being Governor, Last Call for 7.13.23 A prime-time read of whats going down in Florida politics, Gov. Earn rewards when you complete healthy activities. Most plans offer optional adult vision and dental coverage. Im not comfortable with signing this. STAFF LOGIN. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright by Extensive-Enterprises 2023. Members will still need referrals from their brick-and-mortar PCP for care beyond their PCP's scope. If an authorization is needed, you can access our login to submit online. All rights reserved. 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, How to Create Positive New Habits in our New World. Ambetter Value features in-person care from a smaller provider network. Ambetter can help. Its designed to provide you with valuable education and materials to simplify your administrative responsibilitiesso you can focus on providing care. Because protecting peoples health is why were here, and its what well always do. Behavioral Health/Substance Abuse need to be verified by Sunshine Health. Sunshine has 21 days to contest the fines and sanctions. | To create an account please email membership@fhca.org, Florida Health Care Association307 W. Park Ave.P. Is the member being admitted to an inpatient facility? Members can visit a brick-and-mortar PCP but will be subject to applicable cost-sharing. DeSantis appoints Paetra Brownlee to 6th DCA. Florida | Cenpatico Si desea aprender ms, comunquese con el Plan de cuidado administrado. That six-figure total, revealed by AHCA, is higher than Sunshine had previously acknowledged. Nathan DikesPresident and CEO, Sunshine Health Facilities. Previous news accounts detailed how, for months, Sunshine had failed to pay providers for some of the states severely sick children that receive coverage as part of Medicaids childrens medical services portion. Ambetters Gold, Silver and Bronze Marketplace Insurance Plans feature the richest benefits and broadest network. Copyright 2023 Celtic Insurance Company. Sunshine Health Member Services | Ambetter from Sunshine Health Ambetter Provider Network Information - Ambetter from Sunshine Health Sunshine Health is a Managed Care Organization (MCO) contracted with the Florida Agency for Health Care Administration (AHCA) to serve Medicaid and other government services program . All of Sunshine Health's programs, policies and procedures are designed to minimize the To ensure the safety of your protected health information (PHI), please send us a message through the Secure Member Portal or Provider Portal, or you can call us at 1-866-796-0530 to speak directly to a customer service representative. Stay up to date on Ambetter from Sunshine Health provider notices by reviewing and bookmarking Provider News. The Childrens Medical Services Health Plan provider directory is a list of physicians, hospitals and other healthcare providers who are available to help care for members. We provide skilled nursing, psychiatric nursing, dietary support, nutrition management, Alzheimers disease and dementia care, adult family homes, in-patient behavioral health services, and Medicare-certified home health care. Musculoskeletal, Cardiac and ENT services need to be verified by Turning Point Fax: 954-622-8034. It's quick and easy. Sunshine promotes wellness, independence, and dignity for those we serve. Sunshine Health Managed Medical Assistance is a managed care plan providing Medicaid and enhanced benefits to Florida residents of all ages who qualify for Medicaid. Search Now Provider And Pharmacy Directory Information Find everything you need in the member online account. Use your ZIP Code to find your personal plan. All appointment times are guaranteed by our Sunshine Health Cardiologists & Providers. You will need Adobe Reader to open PDFs on this site. Need to make an eye doctor appointment this week? You will need Adobe Reader to open PDFs on this site. My mother has been here for the last 6 years and she is always well taken care of, she loves the staff and the staff loves her. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. The claims were identified either through complaints from providers or by the health plan itself. Cloud. Take care of you and your baby with our maternity health programs. It's free! Referrals are not required for OB/GYN, mental health/substance abuse disorder, urgent care or emergent care. Learn more about Zocdoc search Other providers Availability last updated 07/11/2023 Insurance info unavailable Catherine Byrd, OD 61.5 mi Optometrist Search Location Insurance Loading. Ambetter Virtual Access offers members a virtual primary care experience from a broad provider network. Access your secure member account information any time. Use your ZIP Code to find your personal plan. If you need help with other needs, like transportation or community resources, call us at 1-352-840-1102. Valuable dental benefits may be included with your plan to help keep you - and your smile - healthy. Use your ZIP Code to find your personal plan. Sunshine Health ofrece muchas herramientas cmodas y seguras para ayudarle. Limitations, co-payments and restrictions may apply. Use your ZIP Code to find your personal plan. Speech, Occupational and Physical Therapy need to be verified by NIA. Click on your network below to start a search. No paper wasted, no mail piled up in your home, and no misplaced bills! As an Ambetter member, you have access to the helpful tools and resources you need to manage your plan - all in one place, 24/7. For Chiropractic providers, no authorization is required. Cloud. Get personalized help managing diabetes, asthma and other chronic conditions. In order to see a brick-and-mortar PCP, members must formally change their PCP to a brick-and-mortar PCP in the Member Portal or by calling member services before visiting a PCP other than their assigned Teladoc PCP. Provider Directories | Florida Medicaid | Sunshine Health Ambetter from Sunshine Health is our Health Insurance Marketplace product. Vision services, including all services rendered by an Optician, Ophthalmologist, or Optometrist need to be verified byEnvolve Vision *Statistical claims and the #1 Marketplace . Because protecting peoples' health is why we're here, and it's what we'll always do. Best Sunshine Health Cardiologists Near Me | Zocdoc Stay up to date on Ambetter from Sunshine Health provider notices by reviewing and bookmarkingProvider News. Usted tambin tiene acceso a su informacin de atencin mdica. Dial 988 for confidential, free, 24/7/365 support from a trained counselorfor mental health, substance use or suicidal crisis. 1-877-687-1169. La informacin de beneficios que se aporta es un resumen breve, no una descripcin completa de los beneficios. Best Sunshine Health Optometrists Near Me | Zocdoc Are services for HMO members being performed or ordered by a non-participating provider? Fax: (509) 922-9119. Once you have signed in, you will be able to access the Members Only section of FHCA.org. Copyright 2023 Celtic Insurance Company. The following essential providers are part of Sunshine Healths network and are available to all members: You will need Adobe Reader to open PDFs on this site. Contact the Sunshine Health Provider Services Department, 8 am to 7 pm EST/EDT, Mon-Fri, at phone 866-796-0530 or fax 866-614-4955 for assistance with the following services: Questions about claim/credentialing/network status Request for adding physicians to an existing group Request a free copy of our Provider Manual Get medical help from doctors via video and phone. Drug authorizations need to be verified by Envolve Pharmacy Solutions; for assistance call 866-399-0928. Ambetter strives to provide access to a quality healthcare network with the goals: Keep our premiums affordable and lowering costs for members Focus on making providers available who have a history of better healthcare outcomes Make an appointment online instantly with Psychiatrists that accept Sunshine Health insurance. All rights reserved. Quickly and securely pay your monthly premium. Find everything you need in the member online account. Cloud. Its designed to provide you with valuable education and materials to simplify your administrative responsibilitiesso you can focus on providing care. Ron DeSantis declared a state of emergency for Broward County. St. Petersburg, Florida 33704. Not sure what your username and password is, or if you have an account? See what vision and dental coverage is available for you. Musculoskeletal, Cardiac and ENT services need to be verified by Turning Point Fax: 954-622-8034, Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health. Healthy partnerships are our specialty. All rights reserved. So, to make working with us easier, we developed the Ambetter Provider Toolkit. Puede iniciar sesin o registrarse. Search for doctors, hospitals, and specialists near you. Find and enroll in a plan that's right for you. You will need Adobe Reader to open PDFs on this site. Skilled Nursing and Rehabilitation Healthcare in Spokane Valley WA Sunshine Health Provider Resources. Florida Medicaid Pre-Authorization | Sunshine Health No paper wasted, no mail piled up in your home, and no misplaced bills! Ron DeSantis declared a state of emergency for Broward County. Infrmese ms! A review of the data shows that 48,694 long-term care claims were denied for allegedly having wrong diagnosis codes. Find a Provider in your area Provider Network Design We want you to be and stay healthy! All rights reserved. There are more than 5 million people enrolled in Floridas Medicaid program today. It's simple, secure and free. You can also find community resources in your area on the Sunshine Health Community Resource Database. The state is giving Sunshine 30 days to pay the fine. Prior Authorization Guide. Use your ZIP Code to find your personal plan. Members can only see PCPs within their assigned PCP group. Is the member receiving hospice services. Copyright 2023 Celtic Insurance Company. Dental Benefits - Wellcare The Wellcare By Allwell Medicare Provider and Pharmacy Directory is a list of Primary Care Providers (PCPs), physicians, hospitals, drug stores, and other healthcare providers that are available to you. Find an in-network doctor from over 1,000 insurance plans Add your insurance to see in-network doctors See all (1000+) Add your insurance coverage PDF Sunshine Health FAQ - RADMD All rights reserved. You will need Adobe Reader to open PDFs on this site. I love the Residents and the Staff! A referral from a members PCP is needed for care beyond their PCPs scope, such as seeing a specialist. Though Sunshine representatives have said the held-up payments have been processed, some organizations told Fresh Take Florida that payment issues continue to pop up. As a Sunshine Health provider, you can rely on: A comprehensive approach to care for your patients through disease management programs, healthy behavior incentives and . Los beneficios, formularios, red de farmacias, primas y/o copagos/coaseguros pueden cambiar. All rights reserved. with providers, Sunshine Health is committed to: Working as partners with participating providers Demonstrating that healthcare is a local issue Performing its administrative responsibilities in a superior fashion . We believe that delivering quality care doesnt have to be complicated. PDF PROVIDER QUICK REFERENCE GUIDE - Sunshine Health As an Ambetter member, you have access to the helpful tools and resources you need to manage your plan - all in one place, 24/7. Start a search using ourFind A Providertool. As long as I have to be at a place to get well, this is a great place to be. If you need help, call Provider Services at 1-877-687-1169 (Relay Florida 1-800-955-8770) Monday through Friday from 8 a.m. to 8 p.m. Eastern. With Ambetter from Sunshine Health it's easy to take charge of your health. Christine Jordan Sexton March 23, 2022 7 min The state is giving Sunshine 30 days to pay the fine. AHCA levied a fine of $75 for each claim and is asking the company to explain in detail how it has fixed the claims payment process and whether claims have been reprocessed and paid. Learn more aboutAmbetter from Sunshine Health low cost plans that meet your budget. They said, Before we wire money into your account, we want you to sign this document, Ramirez said, according to Fresh Take Florida. Sunshine Health is a managed care plan with a Florida Medicaid contract. For behavioral health provider resources and information, please visit: https://www.sunshinehealth.com/providers.html Earn rewards for taking charge of your health. Florida's largest Medicaid managed care vendor, which came under scrutiny for failing to pay. State regulators also are placing sanctions on Sunshine State Health Plan and requiring the managed care plan to take a series of corrective actions before members can be auto-assigned to the plan.