Billing and Claims
Please see the Provider Billing Manual and Billing Quick Reference Guides (QRGs). The QRGs include targeted claims and authorization instructions per provider type. The guides detail billing guidelines, duplicate billing, corrected claims processes and many more topics.
- Ancillary MMA/SMI/CW Including Home Health, PDN
- Ancillary CMS Including Home Health, PDN
- Ancillary LTC Including Home Health, PDN
- Appeals Guide
- Assisted Living Facility
- Assisted Living Facility – MMA/SMI/CW
- Balance Billing FAQ
- Behavior Analysis (BA)
- Behavioral Health
- Caregiver Support Services For Non-Medicaid Caregivers – CMS
- Claim Research Template (Excel)
- Doula
- Durable Medical Equipment
- Early Intervention Services Providers
- General Information
- Hospice
- Hospitals
- Licensed Midwife
- MFC – Medical Foster Care
- Nursing Facilities – LTC
- Nursing Facilities – MMA/SMI/CW
- Pediatric Nursing Facilities – CMS
- Pediatric Primary Care Providers
- Pediatric Therapy
- PIC:TFK – Partners in Care Together for Kids
- PPEC – Prescribed Pediatric Extended Care
- Primary Care Providers
- Provider Demographic Updates
- Specialists
- Targeted Case Management
- Therapy
- Transportation
Claim Concerns
Follow the appeal and reconsideration procedures outlined in the Provider Manual (PDF) when submitting requests. If, after following these steps, further review is required, please complete the Claim Concerns form.
Outpatient Single Case Agreement Request Form
To expedite the Single Case Agreement (SCA) process for outpatient requests, Sunshine Health requires all providers to fax a completed SCA request form to 1-866-796-0526.