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PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy.TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
TRANSPORTATION SERVICES Transportation to and from all your medical appointments. This could be on the bus, a van that can transport people with disabilities, a taxi or other kinds of vehicles. We cover the following services for members who have no transportation: Out-of-state travel. Transfers between hospitals or facilities. Escorts when medically necessary. OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
ONLINE MEMBER ACCOUNT Your Ambetter Online Member Account. Your Ambetter online member account is a powerful tool you can use anytime to manage your insurance plan. There, you can find information about your Ambetter coverage, access options for care and much more — all in one place. Your Ambetter online member account puts you in control of your healthplan.
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy.TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
TRANSPORTATION SERVICES Transportation to and from all your medical appointments. This could be on the bus, a van that can transport people with disabilities, a taxi or other kinds of vehicles. We cover the following services for members who have no transportation: Out-of-state travel. Transfers between hospitals or facilities. Escorts when medically necessary. OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
ONLINE MEMBER ACCOUNT Your Ambetter Online Member Account. Your Ambetter online member account is a powerful tool you can use anytime to manage your insurance plan. There, you can find information about your Ambetter coverage, access options for care and much more — all in one place. Your Ambetter online member account puts you in control of your healthplan.
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH AND PRO FOOTBALL HALL OF FAME LAUNCHING Sunshine Health and Pro Football Hall of Fame Launching COVID-19 Vaccination Awareness Effort Featuring Derrick Brooks. Date: 04/27/21 Fort Lauderdale, Fla. SUNSHINE HEALTH ENCOURAGES FLORIDIANS TO GET VACCINATED Sunshine Health Encourages Floridians to Get Vaccinated, Continues to Invest in Local Partnerships as Florida Enters Second Year of thePandemic
PROVIDER DIRECTORIES The Sunshine Health provider directory is a list of physicians, hospitals and other healthcare providers that are available to you. Some providers may not perform certain services based on MEMBER TRANSPORTATION Member Transportation Services. Sunshine Health contracts with the following vendors for service: LogistiCare (Member transportation service for Medicaid and Child Welfare Specialty Plan) 1-877-659-8420 Reservations. 1-877-659-8421 Real-Time Ride Assistance (Where’s My Ride) Alivi (Member transportation service for Long Term Care members)OTC MOBILE APP
Shop over the counter from your phone. You can now order your over-the-counter health and wellness products through the new Envolve OTC Mobile App. Order from the app, no need to call. Browse and buy eligible products. Ship right to your home. Check your balance and use your available funds. Get reminders to use your funds before theyexpire.
PRIOR AUTHORIZATION
This list indicates what services require a prior authorization. If there is no prior authorization received from Sunshine Health, the claim for any service noted as needing a prior authorization will bedenied.
BEHAVIORAL HEALTH
Cognitive behavior therapy (CBT) is a type of psychosocial treatment that helps patients to understand the thoughts and feelings that influence behaviors. Pharmacological management includes, most often, prescribing an Antidepressant, anti-anxiety medications, and beta-blockers. Screening Tools: GAD-7. DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred. FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred. FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred.PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
SUNSHINE HEALTH AND PRO FOOTBALL HALL OF FAME LAUNCHING Sunshine Health and Pro Football Hall of Fame Launching COVID-19 Vaccination Awareness Effort Featuring Derrick Brooks. Date: 04/27/21 Fort Lauderdale, Fla. SUNSHINE HEALTH ENCOURAGES FLORIDIANS TO GET VACCINATED Sunshine Health Encourages Floridians to Get Vaccinated, Continues to Invest in Local Partnerships as Florida Enters Second Year of thePandemic
AMBETTER FROM SUNSHINE HEALTH LOGIN Members & Providers - Log into your Ambetter from Sunshine Healthaccount today!
MEMBER TRANSPORTATION Member Transportation Services. Sunshine Health contracts with the following vendors for service: LogistiCare (Member transportation service for Medicaid and Child Welfare Specialty Plan) 1-877-659-8420 Reservations. 1-877-659-8421 Real-Time Ride Assistance (Where’s My Ride) Alivi (Member transportation service for Long Term Care members) ONLINE MEMBER ACCOUNT Your Ambetter Online Member Account. Your Ambetter online member account is a powerful tool you can use anytime to manage your insurance plan. There, you can find information about your Ambetter coverage, access options for care and much more — all in one place. Your Ambetter online member account puts you in control of your healthplan.
PRIMARY CARE
Appointment Standards. Sunshine Health is committed to providing quality and timely care for our members. The following appointment standards outline the timeframes you should expect to get an appointment from your child's PCP, specialist or behavioral healthprovider.
OTC MOBILE APP
Shop over the counter from your phone. You can now order your over-the-counter health and wellness products through the new Envolve OTC Mobile App. Order from the app, no need to call. Browse and buy eligible products. Ship right to your home. Check your balance and use your available funds. Get reminders to use your funds before theyexpire.
PROVIDER CLAIM ADJUSTMENT REQUEST FORM PROVIDER CLAIM ADJUSTMENT REQUEST FORM Use this form as part of Sunshine Health's Provider Claims Inquiry process to request adjustment of claim payment received that does not correspond withpayment expected.
FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred. FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred.PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
AMBETTER FROM SUNSHINE HEALTH LOGIN Members & Providers - Log into your Ambetter from Sunshine Healthaccount today!
PRIOR AUTHORIZATION
This list indicates what services require a prior authorization. If there is no prior authorization received from Sunshine Health, the claim for any service noted as needing a prior authorization will bedenied.
PRIMARY CARE
Appointment Standards. Sunshine Health is committed to providing quality and timely care for our members. The following appointment standards outline the timeframes you should expect to get an appointment from your child's PCP, specialist or behavioral healthprovider.
ONLINE MEMBER ACCOUNT Your Ambetter Online Member Account. Your Ambetter online member account is a powerful tool you can use anytime to manage your insurance plan. There, you can find information about your Ambetter coverage, access options for care and much more — all in one place. Your Ambetter online member account puts you in control of your healthplan.
COVID VACCINE STATUS Let us know your COVID vaccination status. Date: 06/01/21 We are counting on you to protect your loved ones and yourself. MEDICATION PRIOR AUTHORIZATION REQUEST FORM Requests can also be mailed to: Envolve Pharmacy Solutions, Attention: Prior Authorization Department, 5 River Park Place East, Suite 210, Fresno,California 93720. PROVIDER CLAIM ADJUSTMENT REQUEST FORM PROVIDER CLAIM ADJUSTMENT REQUEST FORM Use this form as part of Sunshine Health's Provider Claims Inquiry process to request adjustment of claim payment received that does not correspond withpayment expected.
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred. FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred. FLORIDA MEDICAID & HEALTH INSURANCE Medicaid and Ambetter members can also access telehealth services powered by Teladoc. This service offers 24-hour access to in-network providers for non-emergency health issues. Call Teladoc directly to schedule your appointment at 1-800-835-2362. Providers:PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
TELEHEALTH SERVICES
Don’t wait for an in-person visit. You can get easy access to a doctor when you want to see one. Sunshine Health offers telehealth services at no cost to you. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or aCREDENTIALING
Requests to release information are to be submitted in writing via email to the Sunshine Health Credentialing Department at SUNCredEscalated@CENTENE.COM or directly to Sunshine Health, Attn: Credentialing Department at: PO Box 459089, Fort Lauderdale, FL33345-9089.
OVER-THE-COUNTER HEALTH & WELLNESS CATALOG Over-the-Counter Health & Wellness Catalog Your Benefit and Inventory Availability Guide Catálogo de salud y bienestar de artículos deventa libre
2021 CHILD WELFARE OVER-THE-COUNTER HEALTH & WELLNESS CATALOG 2021 Child Welfare . Over-the-Counter Health & Wellness Catalog . Your Beneft and Inventory Availability Guide . Catálogo de salud y bienestar de artículos de venta libre DURABLE MEDICAL EQUIPMENT (DME), HOME HEALTH & HOME Durable Medical Equipment (DME), Home Health & Home 1301 International Parkway Suite 400 Infusion Referral Form Sunrise, FL 33323 .1-866-796-0530
2021 PRESCRIPTION DRUG LIST Formulary Introduction FORMULARY . The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand andgeneric
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred.PORTAL FOR MEMBERS
Member/Caregiver Portal. Create your own online account today! Sunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login button. A new window will open. You can login or register. Creating an account is free and easy. SUNSHINE HEALTH PROVIDER PORTAL & RESOURCES InterQual Connect (IQC) is an integrated medical review solution, enabling payers and providers to streamline the medical review process and eliminate redundant reviews. A key component of meeting provider needs is our Secure Provider Portal, which enables providers to conduct business with Sunshine Health from the convenience of theirdesktops
AMBETTER FROM SUNSHINE HEALTH LOGIN Members & Providers - Log into your Ambetter from Sunshine Healthaccount today!
PRIOR AUTHORIZATION
This list indicates what services require a prior authorization. If there is no prior authorization received from Sunshine Health, the claim for any service noted as needing a prior authorization will bedenied.
PRIMARY CARE
Appointment Standards. Sunshine Health is committed to providing quality and timely care for our members. The following appointment standards outline the timeframes you should expect to get an appointment from your child's PCP, specialist or behavioral healthprovider.
ONLINE MEMBER ACCOUNT Your Ambetter Online Member Account. Your Ambetter online member account is a powerful tool you can use anytime to manage your insurance plan. There, you can find information about your Ambetter coverage, access options for care and much more — all in one place. Your Ambetter online member account puts you in control of your healthplan.
COVID VACCINE STATUS Let us know your COVID vaccination status. Date: 06/01/21 We are counting on you to protect your loved ones and yourself. MEDICATION PRIOR AUTHORIZATION REQUEST FORM Requests can also be mailed to: Envolve Pharmacy Solutions, Attention: Prior Authorization Department, 5 River Park Place East, Suite 210, Fresno,California 93720. PROVIDER CLAIM ADJUSTMENT REQUEST FORM PROVIDER CLAIM ADJUSTMENT REQUEST FORM Use this form as part of Sunshine Health's Provider Claims Inquiry process to request adjustment of claim payment received that does not correspond withpayment expected.
PROVIDER DISPUTE FORM PROVIDER DISPUTE FORM Use this form as part of Sunshine Health's Provider Dispute process to request review of claim and non-claim matters . NOTE: Non-Claim disputes must be submitted 45 calendar days from the original date the issue(s) occurred. Skip to Main Content Select Your Plan Belowsearch
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Our health insurance programs are committed to transforming the health of the community one individual at a time. * Health Insurance Marketplace Plan* Healthy Kids Plan
* Comprehensive Long Term Care Plan* Medicaid Plan
* Medicare Advantage * Child Welfare Plan HURRICANE DORIAN ALERTMEMBERS
EMERGENCY PLANNING: Hurricane season runs through Nov. 30. It is important to create an Emergency Plan for you and your family. If you do not already have one, visit FloridaDisaster.org for help with making a plan and preparing for a hurricane.
MEDICATION REFILLS: Gov. Ron DeSantis declared a state of emergency in all 67 counties, which means you may refill your prescription medications early in advance of the storm. Please contact your pharmacy for more information. If you have a medical emergency during the storm, please call 911. MEMBER SERVICES: Member Services at 1-866-796-0530 (TTY 1-800-955-8770) is open as usual from 8 a.m. to 8 p.m. Monday-Friday. Also as usual, members can call Member Services at any time, day or night, to reach our 24-hour Nurse Advice Line. Members experiencing a medical emergency should call 911. TELEHEALTH: Our telehealth provider Teladoc is offering non-emergency medical care at no cost to you for all residents of Florida who are affected by the hurricane. They can help you with non-emergency conditions, like coughs or sore throats. You don’t have to be a Sunshine Health member to use Teladoc during this period. Call: 1-855-225-5032. Read Teladoc Frequently Asked Questions (PDF).PROVIDERS
PROVIDER SERVICES: Provider Services at 1-844-477-8313 (TTY 1-800-955-8770) is open as usual from 8 a.m. to 8 p.m. Monday-Friday. Please note that members can call Member Services at any time, day or night, to reach our 24-hour Nurse Advice Line. CLAIMS: Medically necessary services provided under a state of emergency are covered regardless of provider network participation status and/or service limits. For services provided during this period, claims should be billed following the normal claim submission guidelines outlined in the Sunshine Health Provider Manual (PDF).
Thank you for serving our members every day, and especially duringthis time.
HEALTH INSURANCE MARKETPLACE PLAN Ambetter from Sunshine Health is our Health Insurance Marketplace product. Learn more!GET INSURED
Get more information on the health coverage we provide and what youare eligible for.
ALLWELL FROM SUNSHINE HEALTH A Medicare Advantage plan offering affordable healthcare coverage and benefits you need to take care of yourself. Learn more!NEWSROOM
REMINDER TO PROVIDERS OF RESIDENTIAL OR IN-PATIENT SERVICES: YOU MUST REPORT YOUR EMERGENCY STATUS TO AHCA AHCA requires all licensees providing residential or inpatient services to use an approved database for reporting its emergencystatus.
IMPORTANT NOTICE TO SUNSHINE HEALTH MEMBERS Sunshine Health has identified a possible disclosure of health planinformation.
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