Practitioner Enrollment Requests

Welcome to Sunshine Health’s streamlined, online practitioner enrollment process! We are excited that you are considering adding a new practitioner to your existing Sunshine Health contract. Our new user-friendly form is designed to make this process smoother and more efficient for you. By using this form, you will enjoy several benefits, including:

• Increased accuracy: Clear instructions reduce the chance of errors or missing information.
• Guided process: We will walk you through each step, ensuring you provide all necessary information.
• Quicker turnaround time: Our streamlined approach helps you complete the enrollment faster. By submitting a complete and accurate application, along with the required credentialing documents, you are more likely to achieve a smooth, one-pass enrollment.

• Contractual Status: This form is restricted for adding a practitioner to an existing, contracted group. If the tax ID is not currently contracted with Sunshine Health, please submit a request to Join Our Network. If a request is submitted for a non-contracted group, the request will be returned to you, unprocessed.
• Effective Dates: Sunshine Health will issue an effective date on the first or the fifteenth of the following month upon receipt of a clean practitioner add request. A clean practitioner/facility add request is a request with all the required documents/information attached.
  • Clean applications received before the fifteenth day of the current month will be made effective on the first day of the following month.
  • Clean applications received after the fifteenth day of the current month will be made effective on the fifteenth day of the following month.
• Starting Service: No practitioner should begin servicing Sunshine Health members until they have received a Provider Enrollment Confirmation letter from Sunshine Health’s Provider Enrollment department. Our enrollment process can take up to sixty (60) days to complete. We will not backdate effective dates due to services provided ahead of the practitioner’s enrollment.
• CAQH Access: If your practitioner’s specialty requires credentialing, please ensure that CAQH access has been granted to Centene Corporation and that all information has been attested within the last 120 days.
• List of Affiliated Practitioners (L.O.A.P.): Please ensure that all headers marked in red on the L.O.A.P. (Excel) document are completed. Any missing, required information will delay the enrolment and/or credentialing process.
• Specialty Alignment (Medicaid Only): The taxonomy code listed on AHCA’s Provider Master List (PML) must coincide with the specialty requested for enrollment with Sunshine Health.
  • If the PML requires an update, please work with AHCA to update the specialty before submitting the enrollment request to Sunshine Health.
  • If the specialty/taxonomies do not match the PML, the request will be returned to you, unprocessed.
  • This requirement only applies to our Medicaid products.
  • For more information regarding Medicaid enrollment, please visit Provider Guide: AHCA Rules for Medicaid Enrollment.
• Specialty Alignment (Medicare and Ambetter): The taxonomy code listed on NPPES must coincide with the specialty requested for enrollment with Sunshine Health. 
• Medicaid Eligibility (Medicaid Only): Practitioners who wish to participate in Sunshine Health’s Medicaid products must be enrolled on AHCA’s Provider Master List (PML). We must be able to locate the practitioner by their NPI number on the PML. The practitioner should also have a compliant Medicaid enrollment type of “Limited Enrollment” or “Enrolled.”
  • Providers with “Registered” enrollment status on the PML will be rejected upon submission.
  • Please also ensure that the PML enrollment status is active.
  • If we are unable to validate your practitioner’s active and compliant enrollment status on the PML, the request will be returned to you, unprocessed.
• For all lines of business: The specialty submitted on the List of Affiliated Practitioners (LOAP) and the "primary specialty" appearing on Page 5 of the practitioner’s CAQH application must match.