Sunshine State Health Plan® (Sunshine Health) is pleased to announce that effective  March 22, 2012, we have partnered with Univita Health, Inc., to provide Durable Medical Equipment (DME), Home Health and Home Infusion Pharmacy services to Sunshine Health members. 

Sunshine Health’s selection of Univita was made to ensure that Sunshine Health’s members receive the most from their benefit plan, thus providing a positive impact on the member’s overall healthcare experience.   For Prior Authorization Requests, please contact Univita Health Inc., via fax at 888-914-2202.   Please see attached revised Prior Authorization List here. 

In the meantime, please feel free to contact Provider Services at 1-866-796-0530, with any questions.

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Thank you for choosing Sunshine State Health Plan (Sunshine Health) as your health plan.  Sunshine Health is changing the way we arrange for your Durable Medical Equipment (DME), Home Health (HH), and IV Pharmacy services. However, your benefits are not changing.

These benefits are currently arranged through CareCentrix.  On March 22, 2012, your care will be arranged through Univita Healthcare Solutions.  Covered services will continue to be provided by CareCentrix through March 21, 2012.

In the meantime, if you have any questions about this change, please call our Member Services department toll free at 1-866-796-0530, Monday through Friday, from 8:00 a.m. to 5:00 p.m., Eastern Standard Time.

Please keep this letter with your provider directory.

Thank you again for choosing Sunshine Health as your health plan. We are here to help you find real solutions to your health care needs.

Para informacion en Espanol precione aqui.

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Sunshine State Health Plan (Sunshine Health) is changing the services you get.  This will start on January 01, 2012. 

A list of those changes are:

• Dental – Dental services will no longer be covered by Sunshine Health. You will CONTINUE to get dental services with Medicaid.
• Circumcision – Newborn males while in hospital.
• No extra adult dental benefits
• No extra inpatient hospital day

 You will still get:

• Additional Vision Benefits - Unlimited eye exams and eyeglasses, up to two per year, if medically necessary. 
• Over the Counter Pharmacy Benefits – $25 per household per month.
• Additional Adult Hearing Benefits – Adult benefits up to one hearing exam and one hearing aid every year.

If you need more information about services or benefits click here or please call member services. The number is 1-866-796-0530 (TDD/TTY 1-866-796-0524). You can also look at the web- www.sunshinestatehealth.com.

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Pursuant to statute 409.912(51) The Agency may not pay for a psychotropic medication prescribed for a child in the Medicaid program without the express and informed consent of the child’s parent or legal guardian. The physician shall document the consent in the child’s medical record and provide the pharmacy with a signed attestation of this documentation with the prescription.

Florida Statute 394.492(3) “Child” means a person from birth until the person’s 13th birthday.

Psychotropic (Psychotherapeutic) Medications include antipsychotics, antidepressants, antianxiety medications, and mood stabilizers. Anticonvulsants and ADHD medications (stimulants and non-stimulants) are not included at this time.  The generic names of those medications subject to the informed consent are listed here.

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Effective August 1, 2011, Sunshine State Health Plan® has changed the timeframe on our claims adjustment policy from 45 days to 90 days.  If you have any questions, please call Provider Services at 1-866-796-0530 or contact your Provider Relations Representative.

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Sunshine State Health Plan® (Sunshine Health) will soon initiate the implementation of the Electronic Data Interchange (EDI) Version 5010 in accordance with the federal Health Insurance Portability and Accountability Act (HIPAA) rules for all EDI transactions.  HIPAA rules mandate that the implementation of EDI Version 5010 will begin January 1, 2012.  From October  1, 2011, through December 31, 2011, Sunshine Health will support a dual-strategy approach to the implementation of EDI HIPAA Version 5010.  Trading partners will be able to submit version 4010 transactions through December 31, 2011; however, trading partners that have passed the EDI HIPAA Version 5010 testing and certification requirements may send version 5010 transactions beginning October 1, 2011. 

Sunshine Health is working with Edifecs  to ensure a successful transition to the new formats.  Trading partners are required to complete HIPAA Version 5010 testing and certification using the Centene Edifecs Ramp Management Testing Facility.  To obtain access to the HIPAA Version 5010 Companion Guides, sample files, and FAQs trading partners must enroll on the Centene Edifecs Ramp Management site: www.centene.com/edifecs

Additional information regarding HIPAA Version 5010 will be communicated on the Centene Edifecs Ramp Management site, and distributed to trading partners that have enrolled for testing on the Centene Edifecs Ramp Management site.  

Questions? Contact the EDI Helpdesk at ediba@centene.com or 1-800-225-2573 X25525.

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Effective September 01, 2011, Sunshine State Health Plan® (Sunshine Health) has revised the prior authorization requirements for Medicaid Members.  For more information click here.

Specifically the following changes will occur:

Removed
• Nuclear Cardiology

Added
• Hospital Outpatient Surgery (Must be requested by ordering physician)

Should you have any additional questions, please contact Provider Services at (866) 796-0530 or your Provider Relations Representative.

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Sunshine State Health Plan is moving our office!

Our new address will be:  Sunshine State Health Plan,  1301 International Parkway, 4^th Floor, Sunrise, FL 33323.

The address change will be effective starting August 15, 2011. This is for letters, grievances or appeals.

Please call our Member Services Department if you have any questions.  Their number will stay the same.  It is 1-866-796-0530.

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Sunshine State Health Plan is making some changes to our Preferred Drug List.  The changes will start August 7, 2011.  To view these changes click here.

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Outpatient Imaging Program Provider Education Webinars

In an effort to continue promotion of quality improvement for services provided to Sunshine State Health Plan (Sunshine Health) members, Sunshine Heath has entered into an agreement with National Imaging Associates, Inc (NIA), an affiliate of Magellan Health Services, to implement an outpatient imaging program.  This program includes the management and prior authorization of non-emergent, advanced, outpatient radiology services.

Effective June 1^st 2011, an outpatient imaging program will be implemented for diagnostic procedures including CT/CTA/CCTA, MRI/MRA, and PET Scans.

Sunshine Health and NIA welcome you to attend one of our upcoming Provider Education Webinars to learn more about NIA’s outpatient imaging program and what it means to you.   Hour-long Provider Education Webinars will take place on the following dates:

• Wednesday, May 18th  
• Thursday, May 19th       
• Friday, May 20th
• Monday, May 23rd   
• Tuesday, May 24th 
• Wednesday, May 25th   
• Thursday, May 26th

Webinar sessions will be held at 8:00 am and 12:00 pm EST each day.  You will need a computer with Internet access to view the education materials presented during the Webinar.

Please RSVP at least 1 week prior to the education seminar you plan to attend by calling an NIA representative at 1-800-327-0641.   After your RSVP, you will receive a confirmation email from NIA for the Webinar session you selected.  The confirmation email will also include a toll-free dial in number with access code and web meeting address.

Sunshine Health and NIA look forward to working with you to ensure that your Sunshine Health members receive diagnostic imaging services delivered in a quality, clinically appropriate fashion.

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