Sunshine Health Utilization Management

Listing Websites about Sunshine Health Utilization Management

Utilization Management Sunshine Health

(5 days ago) WebThe Sunshine Health utilization management program serves to: Ensure confidentiality of personal health information ; Initiate process improvement activities to enhance …

https://www.sunshinehealth.com/content/sunshine-new/en_us/providers/utilization-management.html

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Florida Medicaid & Health Insurance Sunshine Health

(1 days ago) WebNotification of Business Process Change for Checking Claims Status. Use the Secure Provider Portal to check the status of claims. Sunshine Health offers affordable Florida …

https://www.sunshinehealth.com/

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Sunshine Health Member Healthcare Resources Sunshine Health

(7 days ago) WebSunshine Health is committed to providing our members with the resources they need to get the best care possible. In this section, we provide information, education and …

https://www.sunshinehealth.com/members/smi/resources.html

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Providing Quality Care - Sunshine Health

(8 days ago) WebUtilization Management (UM) decisions are based only on the appropriateness of care and service and the existence of coverage. Sunshine Health does not reward providers, …

https://www.sunshinehealth.com/providers/quality-improvement/quality-care.html

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Clinical & Payment Policies Provider Resources

(4 days ago) WebClinical Policies. Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules. They include but are …

https://www.sunshinehealth.com/providers/utilization-management/clinical-payment-policies.html

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Care Management Sunshine Health

(3 days ago) WebContact your child’s Care Manager’s supervisor. If you don’t know who your child’s care manager’s supervisor is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770 …

https://www.sunshinehealth.com/members/smi/resources/care-management.html

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Clinical Review Nurse - Prior Authorization, Remote-FL

(6 days ago) WebCollects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines Assists with …

https://jobs.centene.com/us/en/jobs/1495559/clinical-review-nurse-prior-authorization/

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Get the Most from Your Coverage Sunshine Health

(8 days ago) WebYour Member Handbook is a great source for information about your coverage and benefits. It also lists important phone numbers. You can also contact Member Services for …

https://www.sunshinehealth.com/members/LongTermCare/MemberResources/quality-program.html

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Continuity of Care Sunshine Health

(1 days ago) WebUtilization Management. Clinical & Payment Policies; Continuity of Care; Incentives Statement; Value-Based Incentive Programs. (COC) period in which Sunshine Health …

https://www.sunshinehealth.com/content/sunshine-new/en_us/providers/utilization-management/continuity-and-continuation-of-care.html

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Incentives Statement Provider Resources Sunshine Health

(6 days ago) WebUtilization denials are based on lack of medical necessity or lack of covered benefit. Sunshine Health and its delegated health plan partners have utilization and claims …

https://www.sunshinehealth.com/content/sunshine-new/en_us/providers/utilization-management/incentives-statement.html

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General Quick Reference Guide for Providers - Sunshine Health

(2 days ago) WebPrior-authorization requests are processed by Sunshine Health’s Utilization Management (UM) Sunshine Health at 1-844-877-8313 to update your address in our systems. …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/SH-PRO-PE-General%20QRG.pdf

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Portal for Members Login Sunshine Health

(1 days ago) WebSunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login …

https://www.sunshinehealth.com/login.html

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Sunshine Health Provider Portal & Resources Sunshine Health

(5 days ago) WebUnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as …

https://www.sunshinehealth.com/providers.html

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Member Services Sunshine Health

(6 days ago) WebContacting Member Services. You may call us at 1-866-796-0530, or TTY at 1-800-955-8770, Monday through Friday, 8 a.m. to 8 p.m., but not on state approved holidays (like …

https://www.sunshinehealth.com/members/medicaid/benefits-services/member-services.html

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Manuals, Forms and Resources Sunshine Health

(1 days ago) WebSunshine Health Payment Policies; Provider Payment forms. Provider Dispute Form (PDF) W-9 Form (PDF) Medical Management Prior Authorization Resource. Medicare Pre …

https://www.sunshinehealth.com/providers/resources/forms-resources.html

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Contact Us Sunshine Health

(6 days ago) WebAmbetter: 1-833-750-1160. For questions on the formulary or a drug that is provided through a retail pharmacy or specialty pharmacy call. Ambetter, Medicaid, Serious Mental Illness …

https://www.sunshinehealth.com/providers/contact-us.html

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Contact Us Florida Medicaid Sunshine Health

(3 days ago) WebPlease fill out the below form or contact us at 1-866-796-0530 . Your inquiry will be reviewed. A Sunshine Health representative may contact you regarding your inquiry. If …

https://www.sunshinehealth.com/content/sunshine-new/en_us/contact-us.html

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Florida Healthcare & Medicaid Plans Sunshine Health

(1 days ago) WebWe believe local partnerships enable meaningful, accessible healthcare. Sunshine Health is a Florida Medicaid health plan and a wholly-owned subsidiary of Centene Corporation, …

https://www.sunshinehealth.com/content/sunshine-new/en_us/about-us.html

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(5 days ago) WebBehavioral Health Utilization Management covers mental health and substance use services. Phone number: 1-844-477-8313, Select the Product (Option 3 for MMA, 4 for …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/SH-PRO-CM-Resource%20Guide.pdf

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Quality Improvement Program Sunshine Health

(2 days ago) WebSunshine Health involves providers within our plan. The providers assist with developing and monitoring activities of the QI Program as well as providing insight into preventive …

https://www.sunshinehealth.com/members/LongTermCare/MemberResources/quality-improvement.html

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Sunshine DME and Home Health Editable

(2 days ago) WebStandard Request Fax to 1-866-534-5978 Hospital Discharges Fax to 1-844-801-8413 LTC DME/HH Fax to 1-855-266-5275. P.O. Box 459089 Fort Lauderdale, FL 33345-9089. 1 …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/15838_Sunshine_DME-and-Home-Health-editable.pdf

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