Sunshine State Health

The Authorizations Page is Under Construction. Exciting Improvements Coming May 21, 2012!

vhoshing — Mon, 14 May 2012 17:07:46 +0000

The Authorizations page is currently under construction. Look forward to exciting improvements coming May 21, 2012! You may continue to submit authorizations to the Prior Authorization Department FAX at 1-866-796-0526 or call us at 1-866-796-0530.

Effective June 1st, 2012, Sunshine Health Revised Prior Authorization Requirements for Medicaid Members

vhoshing — Mon, 23 Apr 2012 17:18:46 +0000

Effective June 1^st, 2012, Sunshine State Health Plan^®(Sunshine Health) has revised the prior authorization requirements for Medicaid Members.

Specifically, the following changes will occur:

REMOVED

Cardiac Rehab
Stereotactic Radiosurgery
Ambulatory/Video EEG
Sleep Studies

ADDED

Global notification of prenatal care

Should you have any additional questions, please contact Provider Services at (866)796-0530 or your Provider Relations Representative. Please click here for Prior Authorization List (effective June 1, 2012).

PaySpan Health EFT/ERA (PayFormance) Conducts Free Webinars

vhoshing — Wed, 04 Apr 2012 15:46:36 +0000

PaySpan Health EFT/ERA (PayFormance) will be conducting webinars at the below times. If Sunshine State Health Plan providers would like to join, please click one of the links below to register for a free webinar about PaySpan Health.

Wednesday, April 11th 10AM EASTERN TIME https://www2.gotomeeting.com/register/392246338

Wednesday, April 11th 2PM EASTERN TIME https://www2.gotomeeting.com/register/319298554

Thursday, April 12th 10AM EASTERN TIME https://www2.gotomeeting.com/register/473977082

Thursday, April 12th 4PM EASTERN TIME https://www2.gotomeeting.com/register/305009642

Friday, April 13th NOON EASTERN TIME https://www2.gotomeeting.com/register/697502722

Sunshine Health is Pleased to Announce that Effective March 22, 2012, We have Partnered with Univita Health, Inc.

vhoshing — Mon, 26 Mar 2012 20:06:17 +0000

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.

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

Sunshine Health Will Implement a New Procedure to Address the Growing Problem of Fraud, Waste and Abuse (FWA) in Health Care

vhoshing — Thu, 22 Mar 2012 18:52:40 +0000

Sunshine State Health Plan wants to inform you that we will be implementing a new procedure to address the growing problem of Fraud, Waste and Abuse (FWA) in health care. We will be instituting this new fraud detection and prevention procedure in conjunction with our Corporate Office, Centene Corporation, and our strategic business partner HealthCare Insight (HCI). This new procedure will help protect us from the unnecessary expenditures resulting from fraudulent, wasteful and abusive claims and will create more accurate and equitable reimbursement for all billing providers. To learn more click here.

Payformance Corporation Announces Name Change to PaySpan®, Inc.

vhoshing — Thu, 22 Mar 2012 18:26:02 +0000

JACKSONVILLE, FL., February 20, 2012 – Payformance Corporation, a leading provider of healthcare payment and reimbursement automation, announces today its corporate name change to PaySpan®, Inc. The new name is designed to further establish the Company’s unique market identity and expanding product offerings that serve healthcare payers, providers, consumers and the Financial Services industry.

For more information, click http://www.payspan.com/wp-content/uploads/2012/02/PR-Payformance-Name-Change.pdf.

Sunshine Health is Planning to Enhance the Edits in Claims Processing System Effective May 18, 2012

vhoshing — Wed, 21 Mar 2012 15:49:34 +0000

Sunshine State Health Plan is planning to enhance the edits in our claims processing system to more closely align our system’s edits with AHCA’s standards. These are HIPAA standard edits. Until now, several edits have been considered ‘soft’, meaning that a claim could pass through the claims system even if the edits were not met. When these claims are turned to ‘hard’ edits, billing errors will result in a denial of the claim or claim lines in our processing system.

Starting January 1, 2012, Sunshine State Health Plan is changing the services you get. [Non-Reform Counties]

Lori Pruitt — Fri, 13 Jan 2012 22:32:38 +0000

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.

Effective September 1, 2011, the Bureau of Pharmacy Services Will Implement This Legislative Directive

vhoshing — Mon, 03 Oct 2011 19:08:24 +0000

Effective September 1, 2011, the Bureau of Pharmacy Services will implement this legislative directive as follows:

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.

Informed Consent for Psychotherapeutic Medication Update

vhoshing — Mon, 03 Oct 2011 18:52:52 +0000

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.