Florida Medicaid Options & Plans | Sunshine Health Health Savings Accounts (HSAs) are available with certain Bronze plans. Behavioral Health (BH) and Mental Health (MH) under Medical Assistance is separate from the physical health managed care system and will not be discussed in this publication. 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, Find Your Provider Relations Representative. Affordable Health Insurance in Florida | Ambetter from Sunshine Health Get the health coverage you deserve. Please see important information on Hurricanes Ian and Nicole. Centene did not mention Floridas sanctions, including its decision not to contest the fine, in securities filings. Read provider coronavirus guidance. 2022 Superior HealthPlan. Healthcare Based on 58 salaries Case Manager 10 salaries Long Term Care Case Manager 5 salaries View More Product & Project Management Based on 26 salaries Program Coordinator 10 salaries Program Specialist 4 salaries View More Business Based on 17 salaries You also have access to your healthcare information. If you need help with other needs, like transportation or community resources, call us at 1-352-840-1102. It also required the company to demonstrate within 30 days that future claims were being paid promptly and asked for weekly updates in phone calls with the CEO, Nathan Landsbaum, or another senior executive. Receive a welcome packet from your plan. Ron DeSantis declared a state of emergency for Broward County. For All rights reserved. Address: 1301 International Pkwy Ste 400 Sunrise, FL, 33323-2874 United States See other locations Phone: ? Download the free version of Adobe Reader. Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. We offer: A lifelong partner for your health - Consider your family doctor your "home base.". Contact Us | NC State Health Plan Please contact your local Provider Engagement Administrator with questions. Get Insured Get more information on the health coverage we provide and what you are eligible for. 5210 Belfort Rd Jacksonville, FL, 32256 Get Directions Sunshine Health Jacksonville, FL Reviews 5.0 Former Employee, more than 3 years "Great company" You can donate to support our studentshere. Learn more! Sunshine State Health Plan serves customers in the United States. "Confirm Member ID" must be completed properly before submitting. Learn more about Children's Medical Services. As of December 6, 2021, Sunshine Health providers will notice an increased frequency in their payment schedule. 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. Starting Feb. 1, 2021, Sunshine Healthrequires hospital providers to use inpatient type of bill code 0112 interim when billing first-time claims for interim inpatient stays that exceed 100 consecutive days. Contact Us Do you need more information or have a question? Contact Us | Florida Medicaid | Sunshine Health Modelled Employees (all sites): ? 1001 to 5000 Employees. Deadline passes for Sunshine State Health Plan to challenge $9.1 Focus on individuals. On Oct. 1, 2021, Sunshine Health will combine with Staywell Health Plan, making it the state's largest Medicaid managed care organization. < Customer Claims service is available 24 hours a day, 365 days a year. Learn more about HSA plans on The Fidelity HSA website. The benefit information provided is a brief summary, not a complete description of benefits. 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, Viewdetailed instructions on how to register (PDF), https://member.membersecurelogin.com/sso/login?service=https%3A%2F%2Fmember.membersecurelogin.com%2Fmedicare%2Fj_spring_cas_security_check. Sunshine Health shall ensure that claims are processed and comply with the federal and State requirements set forth in 42 CFR 447.45 and 447.46 and Chapter 641, F.S., whichever is more stringent. Unlock full sales materials and reports Contacts of the primary office for your organization. Secure Portals Member/Caregiver Portal Create your own online account today! Just posted Activate your Coverage Are you no longer eligible for Medicaid coverage? Active local involvement. This story was produced by Fresh Take Florida, a news service of the University of Florida College of Journalism and Communications. Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Creating an account is free and easy. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. The company had said the problems affected one-half of 1% of its 9.2 million total payment claims it processed during the period, or about 46,000 claims. Ambetter can help. 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Florida acknowledged that the companys failures - blamed on technology glitches over nearly three months - were non-willful.. Please complete the captcha by selecting the checkbox, I am not a robot. If you live there, you may refill your prescription medications early. Sunshine State Health Plan Inc - Company Profile and News 4. Please enter your zip code to see plans available in your area. To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit ourTrainingweb page. Cloud. must be checked before submitting. . Sunshine waives any dispute not raised within 21 days, the government had warned the company March 17. Broward Ponders $1.29M Insurance Incentive. The merger is part of Centene's acquisition of. If the request is . They affected children receiving care under the companys Sunshine Health Medicaid program and the Childrens Medical Services Health Plan it operates on behalf of the Florida Department of Health for patients under 21 who are eligible for Medicaid and who have serious, chronic conditions. This is a solicitation for insurance. It distributes funding for legal action, lobbying and other initiatives geared toward eliminating the secrecy that persists in Old Main. Sunshine State Health Plan . 3. The company appointed its vice chairman, Sarah London, as its new CEO on March 22. Gov. An agency spokesperson confirmed Friday that Sunshine State did not file any administrative challenge before the deadline. Individual Member HMO Contract In this . Please ensure these standards are implemented accordingly within your practice. PDF H5190 Sunshine State Dual Eligible Dual Eligible Subset-final Because protecting peoples health is why were here, and its what well always do. If you are a contracted provider, you can register now. Penn State Sunshine Fund Learn more about HSA plans onThe Fidelity HSA website. Florida Medicaid & Health Insurance | Sunshine Health 2022 Su. Get medical help from doctors via video and phone. Please register in advancespace is limited. A flu shot is the best way to protect yourself and those close to you from the flu. The NPI number of this provider is 1609523539 and was assigned on March 2022. Contact Us View contact information for various State Health Plan vendors to address specific questions or concerns. The benefit information provided is a brief summary, not a complete description of benefits. To enter our secure portal, click on the login button. We're here for more than your annual checkup. 2022 Brochures HMO - Ambetter from Sunshine Health June 21, 2023, at 5:54 p.m. Florida Mayors Celebrate Completion of Higher-Speed Rail Line Connecting State. "Confirm Year of Birth" must be completed properly before submitting. Sunshine State Health Plan, Inc. operates as an insurance company. "Sunshine waives any dispute not raised within 21 days," the government had warned the company March 17. Check out all Sunshine Health jobs Sunshine Health Jacksonville, FL office. < Health Advocates are available to provide you with in-person healthcare assistance. PDF 2021 Prescription Drug List - Ambetter from Sunshine Health To enter our secure portal, click on the login button. Download the free version of Adobe Reader. Choose a plan. Sunshine Health is a managed care plan with a Florida Medicaid contract. Sunshine State said the glitches stemmed from the. Healthcare designed for you. URL Codes. It must pay the fine which amounted to $75 for each failure to pay a claim by April 18. Our Health Plans - Wellcare Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan. Find and enroll in a plan that's right for you. Specific prescription benefit plan designs may not cover certain products or categories, regardless of their . 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. PDF PROVIDER QUICK REFERENCE GUIDE - Sunshine Health Required fields are marked with an asterisk (*). Florida Healthcare & Medicaid Plans | Sunshine Health Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health is a managed care plan with a Florida Medicaid contract. We provide quality healthcare coverage with expanded benefits to individuals and families to help them get well and stay well through through our Medicaid, Long Term Care and specialty plans. We provide quality healthcare coverage with expanded benefits to individuals and families to help them get well and stay well through through our Medicaid, Long Term Care and specialty plans. 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. You will need Adobe Reader to open PDFs on this site. Receive a letter to choose a plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. The Community Blue network gives members: All Community Blue plans give members exceptional provider choices, close-to-home - including cancer care, rehabilitation services, behavioral health, emergency care, women's health and children's care. Our family medicine specialists can provide care for you and your loved ones, from preventive care to treatment for illnesses and injuries to chronic care management. Deadline passes for Sunshine State Health Plan to challenge $9.1 Sunshine State previously said the glitches stemmed from the companys merger on Oct. 1 with the second-largest payment vendor, WellCare of Florida Inc. The payment problems left families in Florida with critically ill children who relied on Medicaid-paid health providers stranded. This guide aims to help, More states legalize sales of unpasteurized milk, despite health warnings, Meta launches its rival apThreads as it takes aim at Twitter, Politicians want cop crackdowns on drug dealers. PROCEDURE: 1. s/Claim Complaints: Provider may submit an Informal Claim Adjustment or complaint verbally/telephonically or in writing. Here's what it means, A suspect has been charged with murder in a Philadelphia shooting that killed 5, Florida fines largest Medicaid payment vendor nearly $9.1 million over billing glitches, Website Glitch Prevents Public Comments On Floridas Medicaid Changes, BayCare agrees to $20 million settlement in Medicaid payment case. You will need Adobe Reader to open PDFs on this site. Whole health. If you have a medical emergency, please call 911. Sunshine Health operates Children's Medical Services Health Plan on behalf of the Florida Department of Health, serving children and adolescents with special healthcare needs. Other companies were forced temporarily to cover the costs, effectively floating loans to the health-care giant until they were paid. Make your first payment to access great benefits. We know that we created a number of challenges for our partners that did not meet the standards we set for ourselves or our contractual obligation to the state of Florida, the companys statement said. These companies are each Qualified Health Plan issuers in the Texas Health Insurance Marketplace. For more information contact the Managed Care Plan. Our MAPD plans offer affordable coverage beyond Original Medicare, including a range of benefits such as dental, hearing and vision services; prescription drug services; Flex Cards; transportation services; telehealth visits; wellness programs; in-home support services; and special supplemental benefits for the chronically ill. Wellcares standalone PDPs help to cover the cost of prescription drugs including low monthly premiums and $0 or low co-pays on medications; access to a broad pharmacy network of 60,000 retail locations; easy and convenient delivery of medications; and additional savings on insulin medications. Kristin Bausch - Fresh Take Florida. Schedule yours today! Sunshine Health has a commitment to improving the health of the community one individual at a time. Some providers said they were still experiencing billing issues with Sunshine State. The Company provide health insurance plans and related services. If you experience issues connecting with any of the plans' provider resources, please contact the Agency by using the Florida Medicaid Complaint Form or call our Medicaid Helpline at 1-877-254-1055. You will need Adobe Reader to open PDFs on this site. By communicating withSunshine Health through email, you accept the risks associated thereof. the Plan contractually reports rates to the State of Florida based on claims and/or med records review data. Health Insurance Marketplace Plan Ambetter from Sunshine Health is our Health Insurance Marketplace product. The Ambetter from Sunshine Health Formulary, or Preferred Drug List, is a guide to available brand and generic . Learn more about your flu shot benefit. Your inquiry will be reviewed. Copyright 2023 Celtic Insurance Company. SUNSHINE STATE HEALTH PLAN, INC. | LinkedIn We highlight the stories of Black Floridians seeking emotional healing and wellness. You also have access to your healthcare information. Sunshine State Health Plan Jobs, Employment | Indeed.com 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. Get personalized help managing diabetes, asthma and other chronic conditions. Schedule yours today! Use the filters below to narrow your search results and compare our plans. The Florida Medicaid Preferred Drug List is subject to revision following consideration and recommendations by the Pharmaceutical and Therapeutics (P&T) Committee and the Agency for Health Care Administration. If you have an urgent medical situation please contact your doctor. By continuing to use our site, you agree to our Privacy Policy and Terms and Conditions. Provider Town Halls cover a variety of post-integration updates to better assist you in navigating our processes. Florida's largest Medicaid vendor had until Thursday to dispute the penalty imposed last month by the state Agency for Health Care Administration, leaving the company with one option: pay the fine. Chris Paterson, Plan President and CEO. A Sunshine Health representative may contact you regarding your inquiry. Sunshine State Health Plan, Inc. is a provider established in Plantation, Florida operating as a Health Maintenance Organization. WUSF looks at how distribution of the COVID-19 vaccine exposes inequities in Floridas health care system. The benefit information provided is a brief summary, not a complete description of benefits. A tech glitch was blamed. Can the New Wave of Restaurants Make NYC a Late-Night Dining Town Again? Click on the health plan's link below to find more information on resources for providers. The Changes Summary Report lists only changes made to the Preferred Drug List as a result of the P&T Committee meeting on March 24, 2023 . Questions regarding this update can be emailed to SunshineProviderRelations@Sunshinehealth.com. Sunshine Health offers many convenient and secure tools to assist you. Sunshine State Health Plan Inc. of Tampa had until 5 p.m. Thursday to dispute the large fine imposed last month by its government regulator, the Agency for Health Care Administration, leaving the company with only the option to concede to pay. You can also find community resources in your area on the Sunshine Health Community Resource Database. "Confirm Zip Code" must be completed properly before submitting. Follow Bloomberg reporters as they uncover some of the biggest financial crimes of the modern era. If you are a non-contracted provider, you will be able to register after you submit your first claim. CHOOSE SUNSHINE HEALTH Sunshine Health Provider Portal & Resources | Sunshine Health An option from "Who are you?" Providers do not need to resubmit claims. Please enter your zip code to see plans available in your area. 8 Ratings Sunshine Health Jacksonville, FL isn't hiring right now. A Sunshine Health representative may contact you regarding your inquiry. PDF Massa, Cody - The Agency for Health Care Administration The SMMC program has five types of plans: - Managed Medical Assistance: Provides MMA services to eligible recipients. If you are a contracted Sunshine Health provider, you can register now. Just $139.99 * View More Details Overview Company Description: Key Principal: Chris Paterson See more contacts Industry: Home Health Care Services , Ambulatory Health Care Services , Health Care and Social Assistance , Home health care services This documentary-style series follows investigative journalists as they uncover the truth. Sunshine State Health Plan jobs Sort by: relevance - date 79 jobs Community Health Services Representative new Sunshine State Health Plan 3.2 Hybrid remote in Miami, FL 33135 Estimated $29K - $36.8K a year Coordinate and implement community events such as baby showers, health fairs, and other health education events. "Sunshine waives any dispute not raised within 21 days," the government had warned the company March 17. Centene focuses on long-term growth and value creation as well as the development of its people, systems and capabilities so that it can better serve its members, providers, local communities and government partners. Plan members don't need a referral to see a specialist. If you are a non-contracted provider, you will be able to register after you submit your first claim. Find Your Provider Relations Representative. How Much Does Sunshine Health Pay in 2023? (241 Salaries) Take care of you and your baby with our maternity health programs. Sunshine Health Jacksonville, FL Office | Glassdoor The practitioner's primary taxonomy code is 302R00000X. For more information contact the Managed Care Plan. Use your ZIP Code to find your personal plan. Florida failed to pay thousands of claims for the neediest children.