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What Provider Engagement Account Managers Can Do For You

Sunshine Health has a team of Field Provider Engagement Account Managers (PEAMs) throughout Florida who are committed to supporting providers and addressing your needs. These team members spend several days a week directly engaging with providers in the field focused on performance within our network and strategic initiatives and also work in-house to support strategic initiatives and administrative duties.

To best serve your needs, please use our Find Your Account Manager tool to identify your designated PEAM. Our PEAMs are available via email or can meet with you in person or virtually to assist with a variety of services designed to support the success of your practice:

  • Escalate concerns that remain unresolved after working through the appropriate channels
  • Educate providers on standards for appointment scheduling and after hours
  • Help navigate our public health plan websites and Secure Provider Portals
  • Help navigate our training page to share the numerous in-person and virtual training sessions available to providers about our latest policies, procedures and processes — all free of charge
  • Share provider news and important policy changes
  • Conduct required site visit inspections
  • Invite your team to community events with organizations like Farm Share
  • Support and educate providers on Continuity of Care (CoC) Appointment Agendas, Pay for Performance (P4P), Pay for Quality (P4Q), Behavioral Health Value-Based Care (VBC) incentive programs, and how providers can receive additional incentives for targeted outreach, fulfilling care objectives, and addressing care gaps for members with chronic conditions
  • Quickly identify members who have not been visited a practice and are need care
  • Educate providers on high-cost drugs and alternate methods for providing members with the same quality care
  • Assess and understand trends for hospital readmissions and/or frequent ER visits
  • Offer training both virtually and in person to both provider offices and facilities
  • Audit your practice’s demographics and help providers reconcile their practitioner rosters to  prevent claim discrepancies and ensure office hours and after-hours availability are accurately entered in our system

Please note, our Field PEAMs focus primarily on provider strategic engagement. For inquiries related to provider services or operational issues, please call Providers Services at 1-844-477-8313.

Sunshine Health makes reasonable efforts to resolve claims. Several options are available and can be submitted quickly via the Secure Provider Portals above. If you need more help going through standard channels for claims disputes and appeals outlined in our Provider Manuals, we recommend emailing your concerns to Sunshine_Provider_Relations@SunshineHealth.com so the appropriate team can review further. Please include a reference number or proof of a mailed dispute to open a request. Your PE Account Manager can provide you with the required Claims Template (Excel) to accompany your request.

These resources help keep providers up to date:

Visit the Training page to register for new training sessions or watch previously recorded sessions on subjects such as:

  • Sunshine Health new provider orientation
  • Ambetter new provider orientation
  • How to use the Secure Provider Portal
  • Clinical Documentation Improvement (CDI)
  • Clinical Trainings
  • Cultural Competency
  • HEDIS 101
  • Telemedicine

  • Sunshine Health hosts bi-weekly Provider Town Hall sessions that educate providers on a variety of topics. Join us virtually or in-person.
    • Visit the Training page to register for future sessions or watch recordings of past sessions.
  • If you attended a recent session, please share your feedback by completing the Post Town Hall Survey.
  • We record every town hall and training session so that you and your staff can review the topics that matter to you on your own time.
    • Visit the Training page to review past sessions.

Provider Engagement only supports participating providers. For non-participating inquiries, please call Provider Services at 1-844-477-8313. You can also review the resources available on our public websites shown above.

If you are interested in becoming contracted or looking to add a new product to an existing agreement, please reach out to our contracting department. Visit the Become A Provider page or fill out a Network Participation Request Form.