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.

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.

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.

1.      The prescriber must complete either the Medicaid “Informed Consent for Psychotherapeutic Medication” attestation form; the Department of Children and Families CF1630 form; or provide the court order for the medication.

2.      The completed form must be presented to the pharmacy with every new prescription for a psychotherapeutic medication.  Prescription refills where the original prescription was filled prior to September 1st  will not be denied.   However, pharmacies may not add refills to old prescriptions to circumvent the need for an updated informed consent form.

3.      In order for a prescription claim for a psychotherapeutic medication to pay, the pharmacy must enter the medical certification code “2” to certify that the consent form has been filed with the prescription.  This process is similar to the pre-existing family planning “6” and dialysis “8” code requirements.

4.      The completed form must be filed with the prescription (hardcopy or imaged)  in the pharmacy and held for audit purposes, for a minimum of five years.

5.      Every new prescription will require a new informed consent form.

6.      Prescriptions may be phoned in or emailed for these medications, when the child is less than 13.  However, the pharmacist will need to obtain a completed consent form from the prescriber via fax, mail or from the guardian, prior to dispensing.

7.      The informed consent forms do not replace prior authorization requirements for non-PDL medications or prior authorized antipsychotics for children and adolescents from 0 through 17 years of age.

8.      Medicaid HMOs have been directed to implement the policy, but may chose to operationalize it in a different manner from Medicaid fee-for-service.  They may require something other than a medical certification code.

You may access the Medicaid “Informed Consent for Psychotherapeutic Medication” attestation form here.

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.

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.

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.

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.