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Delegated Credentialing

Thank you for your interest in delegating your entity’s credentialing process from Sunshine Health and Wellcare. This site is intended to provide you with the end-to-end process for initiating and executing a delegated agreement with Sunshine Health. In order to delegate credentialing, you must have an existing Provider Group or Facility/Ancillary contract with Sunshine Health and WellCare. If you do not have an existing agreement with Sunshine Health or Wellcare, please visit our Network Participation Request Form.

The Delegation Process

  1. The following documents must be completed by the provider with signature dates within 30 days of submission:
  2. Upon receipt of the completed documents, the Delegation Team will review the submission package to ensure all signatures are obtained and all documents have been completed in their entirety. It is imperative to ensure complete and accurate documentation is provided to Sunshine health to prevent any delay in the delegation process. Upon receipt of the completed Pre-Delegation Credentialing Questionnaire (PDF), an audit will commence from Sunshine Health’s parent company. During this audit, a random sampling of files will be reviewed to ensure all documents meet Centene’s corporate standards.
    • If any documents are missing or incomplete, the Delegation Team will outreach to the submitter up to three (3) times. If no response is received, the delegation request will be cancelled.
    • Please note that there are variable timeframes to complete each step of the process. Any findings during background check, missing or incomplete documents, or requests for additional information will result in a delay in processing the delegation request.
  3. Sunshine Health will provide an official response to the delegation request, either accepting the request or rejecting the request with rationale, to the original submitter.
  4. Once the request is accepted, Sunshine Health must submit an additional request to the Florida Agency for Health Care Administration (AHCA). The effective date of the delegation agreement must be a minimum of 90 days out from the AHCA submission date. The state approval process can take upwards of 90 days from the health plan submission date to review.
  5. Once approval is received from AHCA, the health plan will request a full roster from the new, approved delegated entity. The roster should include the following information, at minimum:
    • Practitioner name and rendering NPI
    • Group/Practice name and billing NPI
    • Tax ID number and billing address
    • Practitioner demographics:
      • Date of birth
      • Gender
      • Ethnicity (optional, but preferred) – will not display in directory
      • Specialty
      • Board certification, if applicable
      • License information
      • Effective date
    • Service location(s) – up to five (5) locations will be displayed in the directory
    • PCP indication include limitations (Age, Gender, etc.)
    • Directory display indicator (Yes/No)
  6. A countersigned agreement will be provided from the health plan to the provider. The delegation agreement will take effective on the date indicated on the agreement.

Once the delegation agreement is effective, rosters should be submitted to the health plan monthly, or as needed to indicate new enrollments, changes, and terminations. These updates can be submitted via e-mail to SunshineDelegation@CENTENE.COM. Please allow up to 30 days from the roster submission date to process the request.

Instructions

  1. Download and complete the following documents:
  2. Return to this page and fill out the web form below.
  3. Upload the completed documents.
  4. Submit the form.
  5. Upon receipt of the completed web form, a member from our Delegation team will outreach to you with next steps.

Delegation Credentialing Online Form

Do you need to add multiple TINs to this request? required *
Practitioner, Practitioners/Facilities, or Facility required *
If only contracted for Medicare, you can upload a blank document.