Sunshine State HealthPre-Auth Needed?
Our convenient code look up tool will instantly let you know if you need a pre-authorization for a specific procedure, medication or revenue code.
If an authorization is required for the requested procedure, to submit an authorization Login here.
Out-of-network providers must submit a pre-authorization for all procedures. Join Our Network
Please note: Certain services may not be covered. Please refer to the state specific benefit coverage and limitations, including behavioral health and long term care services, age/diagnosis-specific authorization requirements, and self-referral services.
| Behavioral Health, Home Health, DME, Dental, and Vision Please contact Sunshine Health Plan for pre-authorization requirements. Services by a non-participating facility or provider |
|
| Type of service | Authorization Required? |
|---|---|
| Vision services by an optometrist or ophthalmologist are administered by Opticare | NO |
| Dental services administered by MCNA | NO |
| Services in an Public Health or Public Welfare Agency | NO |
| Family Planning services billed with a V25 through V25.9 diagnosis | NO |
| Emergency Room and Urgent Care Services | NO |
| Services by an anesthesiology provider (other than pain management) do not require pre-authorization | NO |
| Participating chiropractic services | NO |
| Services rendered in the home are administered by Univita. | YES |
Disclaimer: Code validation is not a guarantee of payment.