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What Provider Engagement Account Managers Can Do For You

Sunshine Health has a team of Provider Engagement Account Managers located throughout Florida who are committed to supporting providers and addressing your needs. To locate your assigned PE Account Manager, please use our Find Your Account Manager tool. They can help providers:

  • Learn about standards for appointment scheduling and after hours
  • Resolve outstanding issues after working through the appropriate channels
  • Register for training to learn about the latest policies, procedures and processes
  • Navigate our public health plan websites and Secure Provider Portals
  • Share provider news and important policy changes
  • Conduct required site visit inspections
  • Meet your staff virtually and in-person
  • Invite your team to community events with organizations like Farm Share

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

Whenever your practice adds new physicians, you must update your List of Affiliated Providers (LOAP)/Practitioner Roster with the health plan. This guide shows you how to update your roster.

  • 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.