Vendors

Sunshine Health has contracted with the following vendors for service:

  • Access Behavioral HealthExternal Link (Medicaid, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-866-477-6725
    • abhinfo@bhcpns.org
    • Delegated function: Coverage of Services (Behavioral Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Behavioral Health Services, in-lieu services, inpatient and outpatient services, Region 1 only
    • Exclusions: Regions 2-11 will be managed by the Health Plan
  • AliviExternal Link (Medicaid (MMA), Child Welfare Specialty Plan, Comprehensive LTC, Long Term Care, Serious Mental Illness)
    • Reservations between 8 a.m. and 5 p.m. Eastern, Monday through Friday; and Ride Assist (Where’s My Ride?) 24/7, 365 days a year
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee and/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions:  Children’s Medical Services Health Plan, Emergency Transportation
  • AliviExternal Link (Medicare)
    • Reservations: 1-855-519-6684 between 8 a.m. and 5 p.m. Eastern, Monday through Friday
    • Ride Assist (Where’s My Ride?): 1-855-519-6684 (24/7, 365 days a year)
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee &/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions:  Emergency Transportation, Ambulance
  • BioTelemetryExternal Link (Medicaid, Medicare, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-888-312-2328
    • Delegated function: Coverage of Services (Disease Management)
    • Delegated function description: Care Coordination/Case Management, Disease Management
    • Services: Biometric Screening and monitoring, On-Demand Disease Management Program
    • Exclusions: Ages 0-14
  • CareCentrixExternal Link (Medicare)
    • 1-800-808-1902
    • Delegated function: Coverage of Services (Home Health)
    • Delegated function description: Utilization Management (authorizations), Claims Services, Network, Credentialing
    • Services: Home Health, Regions 1-7
    • Exclusions: 
      • Durable Medical Equipment (DME), Non-Medicare Lines of Business
      • Home Health in Regions 8-11
  • CareCentrixExternal Link (Medicare and Ambetter Health)
    • 1-800-808-1902
    • Delegated function: Coverage of Services (Post-Acute Care}
    • Delegated function description: Utilization Management (authorizations),
    • Services: Post Acute Care
    • Exclusions: Medicaid Lines of Business
  • Centene Dental ServicesExternal Link (Commercial/Ambetter Health)
    • 1-855-735-4395
    • Delegated function: Coverage of Services (Dental), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Claims & Provider Payment
    • Services: Dental Services
    • Exclusions: Medicaid, Children's Medical Services Health Plan Title XIX and Title XXI
  • Centene Vision ServicesExternal Link (Medicaid, Commercial/Ambetter Health, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-800-531-2818
    • Delegated function: Coverage of Services (Vision), Provider Services
    • Delegated function description: Utilization Management (authorizations), Service Authorization, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Vision Services (Optometry, Ophthalmology)
  • Central Florida Orthopedics AssociatesExternal Link (Medicaid, Serious Mental Illness, Children's Medical Services Health Plan, Medicare)
    • 1-863-666-3436
    • info@cfosa.com
    • Delegated function: Provider Services
    • Delegated function description: Claims & Provider Payment
    • Services: Claims, Provider Payments, Counties: Orange, Seminole, and Osceola
    • Exclusions: Commercial (Ambetter Health), All counties except Orange, Seminole, and Osceola, which are managed by the Health Plan
  • Coastal Care ServicesExternal Link (Medicaid, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-855-481-0505
    • Delegated function: Coverage of Services (DME, Home Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Toll-Free Provider Help Line
    • Services: DME & Home Health (MMA, CWSP, SMI, CMS)
    • Exclusions: 
      • Home Infusion Services & PDN: managed by the Health Plan for Medicaid Child Welfare Specialty Plan, & Serious Mental Illness.
      • Home Health for Children’s Medical Services Health Plan: Managed by the Health Plan
  • Coastal Care ServicesExternal Link (Medicare)
    • 1-855-481-0505
    • Delegated function: Coverage of Services (DME, Home Health), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Home Health: Regions 8-11; DME: Statewide
    • Exclusions: Home Health Regions 1-7
  • Express ScriptsExternal Link (Medicaid, Commercial/Ambetter Health, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan, Wellcare)
    • 1-800-841-3044
    • Delegated function: Administration and Management Services, Enrollee Services, Provider Services
    • Delegated function description: Pharmacy Benefit Management, Mailing Fulfillment, Network Management, Provider Credentialing & Contracting, Claims & Provider Payment, Toll-Free Provider Help Line
    • Services: Pharmacy Benefit Management
  • Dental MCOs – (Medicaid dental benefits are not administered by Sunshine Health)
  • Dermatology Network SolutionsExternal Link [parent company Provider Network Solutions] (Medicare)
    • 1-844-222-3535
    • Delegated function: Coverage of Services (Dermatology), Provider Services
    • Delegated function description: Utilization Management (authorizations), Network Management, Provider Contracting, Claims & Provider Payment
    • Services: Dermatology (Miami-Dade, Broward, Palm Beach, Martin and St. Lucie counties)
    • Exclusions: All counties except Miami-Dade, Broward, Palm Beach, Martin, St. Lucie will be Managed by the Health Plan
  • DentaQuestExternal Link (Medicare)
    • 1-833-206-6288
    • Delegated function: Coverages of Services, Enrollee Services, Provider Services, Quality
    • Delegated function description: Utilization Management, Network Management, Provider Credentialing and Recredentialing, Claims Processing, Member Call Center, Provider Call Center, Quality Improvement
    • Services: Dental Services
    • Exclusions: Non-Medicare Lines of Business
  • EvolentExternal Link
    • CardiologyExternal Link
      • Medicare
      • 1-888-999-7713
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management
      • Exclusions: Emergent services, Non-Elective Inpatient Services
    • High-Tech Radiology, Cardiac Imaging and Musculoskeletal
      • Medicaid (MMA), Child Welfare Specialty Plan (CWSP), Serious Mental Illness, Children's Medical Services Health Plan (CMS)
      • Child Welfare Specialty Plan (CWSP)
      • Commercial (Ambetter Health)
      • Medicare
      • Web PortalExternal Link
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System
      • Exclusions: Long Term Care Line of Business
    • OncologyExternal Link
      • Medicaid (MMA), Medicare, Commercial (Ambetter Health), Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI) and Children's Medical Services Health Plan (CMS)
      • 1-888-999-7713
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management
      • Exclusions: Long Term Care Line of Business
    • PT, OT, ST TherapyExternal Link
      • Commercial (Ambetter Health)
      • 1-800-424-4909
      • Delegated function: Coverage of Services
      • Delegated function description: Utilization Management, Service Authorization, Coverage of Services, Toll-Free Provider Help Line, Provider Complaint System
      • Exclusions: Non-Ambetter Health Line of Business
  • Florida Care Management Services AgencyExternal Link (FCMSA) (Long Term Care)
    • 1-877-462-1200
    • Delegated function: Coverage of Services, Enrollee Services
    • Delegated function description: Care Coordination/Case Management, Utilization Management, Service Authorization, Enrollee Toll-Free Help Line
    • Services: Care Coordination/Case Management, Utilization Management
    • Services: Care Coordination/Case Management, Utilization Management for a subset of members in Regions 9-11
    • Exclusions: Regions 1 to 8
  • GT-IndependenceExternal Link (Long Term Care)
    • 1-877-659-4500
    • Delegated function: Coverage of Services, Enrollee Services
    • Delegated function description: Participant Direction Option (PDO), Enrollee Material, Enrollee Toll-Free Help Line, Mailing Fulfillment
    • Services: PDO
  • Health Network OneExternal Link (Medicare)
    • 1-800-595-9631
    • Delegated function: Coverage of Services (Dermatology), Provider Services
    • Delegated function description: Utilization Management (authorizations), Service Authorization, Network Management, Provider Credentialing & Contracting, Claims & Provider Payment
    • Services: Dermatology (Lake, Orange, Osceola and Seminole counties)
    • Exclusions: All counties except Lake, Orange, Osceola, Seminole will be managed by the Health Plan
  • Hearing Care SolutionsExternal Link (Medicare)
    • 1-866-344-7756
    • Delegated function: Coverage of Services (Hearing), Provider Services
    • Delegated function description: Enrollee Toll-Free Help Line, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Audiology
    • Exclusions: Non-Medicare Lines of Business
  • HearUSAExternal Link (Medicaid, Commercial/Ambetter Health, Comprehensive LTC, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-855-242-4935
    • Delegated function: Enrollee Services, Provider Services
    • Delegated function description: Enrollee Toll-Free Help Line, Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Audiology
    • Exclusions: Medicare
  • HHAeXchange (Medicaid, Children's Medical Services Health Plan)
    • 1-844-477-8313
    • Delegated function: Coverage of Services, Administration & Management Services
    • Delegated function description: Participant Direction Option (PDO), EVV Vendor, Electronic Visit Verification
    • Services: EVV, Billing Services, Portal
  • LabCorpExternal Link (Medicaid, Commercial/Ambetter Health, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-800-845-6167
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • LabCorpExternal Link (Medicare)
    • 1-800-845-6167
    • Delegated function: Provider Services
    • Delegated function description: Exclusive only for Wellcare Medicare
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Little Havana Activities & Nutrition CenterExternal Link (Long Term Care)
    • 1-305-858-0887
    • Delegated function: Provider Services, Enrollee Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment, Mail Fulfillment
    • Services: LTC Provider Services, Only Regions 9-11
    • Exclusions: Regions 1-8
  • Liberty DentalExternal Link Plan (Children Medical Services Health Plan Title XXI)
    • 1-888-352-7924
    • Delegated function: Coverage of Services (Dental), Coverage of Services, Provider Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment, Enrollee Material, Enrollee Toll-Free Help Line, Utilization Management, Service Authorization
    • Exclusions: Medicaid, Ambetter Health, Medicare & Children's Medical Services Health Plan Title XIX
  • Medical Transportation Management (MTM)External Link (Children's Medical Services Health Plan)
    • Routine Reservations: 1-844-399-9469 (TTY 711) between 8 a.m. and 7 p.m. Eastern, Monday through Friday, and 8 a.m. to 5 p.m. Eastern Saturday
    • Ride Assist (Where’s my Ride): 1-888-597-1185 (24/7, 365 days a year)
    • ReservationsExternal Link
    • Delegated function: Coverage of Services (Transportation), Enrollee Services, Quality, Provider Services
    • Delegated function description: Enrollee Material, Enrollee Toll-Free Help Line, Satisfaction & Experience Surveys (Enrollee &/or Provider), Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: Non-Emergent Transportation
    • Exclusions: Non-Children’s Medical Services Health Plan; Emergency Transportation
  • Medical Transportation Management (MTM)External Link (Medicaid, Comprehensive LTC, Serious Mental Illness, Child Welfare Specialty Plan, Children's Medical Services Health Plan)
    • 1-866-848-9428 between Monday-Friday from 8 a.m. to 4:30 p.m. Eastern
    • Delegated function: Coverage of Services, Enrollee Services, Quality, Provider Services
    • Delegated function description: Network Management, Provider Credentialing & Contracting, Toll-Free Provider Help Line, Provider Complaint System, Claims & Provider Payment
    • Services: HCBS Therapy (art, equine, music, pet)
      • Ages 21 & older for Medicaid, Comprehensive LTC, Serious Mental Illness; Or
      • EPSDT under age 21
    • Exclusions:
      • Under age 21 that does not fall under EPDST guidelines,
      • Long Term Care, Medicare, Commercial (Ambetter Health)
      • Authorizations, which are issued by the Health Plan
  • Premier Eye CareExternal Link (Medicare)
    • 1-855-749-1911
    • Delegated function: Coverage of Services, Provider Services
    • Delegated function description: Utilization Management, Network Management, Provider Credentialing, Toll-Free Member Calls, Toll-Free Provider Calls, Provider Complaints
    • Services: Vision Services
    • Exclusions: Medicaid, Commercial/Ambetter Health, Child Welfare Specialty Plan, Long Term Care, Serious Mental Illness, Children Medical Services
  • Quest DiagnosticsExternal Link (Medicaid, Commercial/Ambetter Health, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan)
    • 1-866-697-8378
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Quest DiagnosticsExternal Link (Medicare)
    • 1-866-697-8378
    • Delegated function: Provider Services
    • Delegated function description: Lab vendor.
    • Services: Lab Services, Specialized Testing, STAT & Same Day Testing
  • Surgery One (Medicaid (MMA), Serious Mental Illness, Medicare)
    • 1-352-275-5478
    • Delegated function: Provider Services
    • Delegated function description: Claims & Provider Payment
    • Services: Claims, Provider Payments, Counties: Orange, Seminole, and Osceola
    • Exclusions: Commercial (Ambetter Health), All counties except Orange, Seminole, and Osceola, which are managed by the Health Plan
  • TurningPointExternal Link (Medicaid (MMA), Medicare, Commercial/Ambetter Health, Child Welfare Specialty Plan, Serious Mental Illness, Children Medical Services Health Plan)
    • 1-855-415-7483
    • Web PortalExternal Link
    • Delegated function: Coverage of Services
    • Delegated function description: Utilization Management, Service Authorization, Toll-Free Provider Help Line, Provider Complaint System
    • Services: Cardiac Procedures and ENT
    • Exclusions: Long Term Care Line of Business