healthsun provider enrollment

TTY users should call 877-206-0500. HealthSun Health Plans is an HMO plan with a Medicare Contract and a Medicaid contract with the State of Florida Agency for Health Care Administration. Provider enrollment doesnt have to be such a painstaking process. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Healthsun Provider Portal Login will sometimes glitch and take you a long time to try different solutions. Your South Florida Medicare Provider - HealthSun Health . View our Summary of Benefits for plans and service areas available to you. Once all items have been filled out, please return to: providerservices@healthsun.com. The Agency for Health Care Administration (AHCA) has created a streamlined application, or Limited Enrollment, for providers who do not hold a Medicaid ID and need to complete basic credentialing which may be a prerequisite to seeking a contract with a Medicaid health plan. In the most basic terms, provider enrollment (sometimes referred to as payer enrollment) is the process through which healthcare providers apply to be included in a health insurance network. Call Provider Services at 1-844-477-8313 or Fax 1-866-614-4955 with questions about claims, credentialing or network status Review an Overview of Billing Guidelines for Medical Foster Care Services (PDF) As a Sunshine Health provider, you can rely on: These teams provide coordination of provider enrollment functions, provider data maintenance, outreach, education, and issue resolution to providers, the Medicaid managed care plans, the Medicaid Regional Offices, and program operating partners at the Department of Health and the Agency for Persons with Disabilities. For more information contact the Managed Care Plan. Our hours of operation are Monday through Friday, 8am to 8pm. Every year . Requests to release information are to be submitted directly to Sunshine Health, Attn: Credentialing Department at. OR: 2. If you are not contracted with Sunshine Health, complete the Network Participation Request Form below. Preferred Medicare Assist Palm Beach (HMO D-SNP) 1-855-874-6282 (TTY 711) Preferred Medicare Assist Plan 2 (HMO D-SNP) Toll-Free. Provider enrollment starts with identifying which insurance companies, or payers, you want to partner with. LoginAsk is here to help you access Healthsun Provider Portal Login quickly and handle each specific case you encounter. How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, Requests for credentialing status can be made by calling Provider Services at. We're glad to hear that you are interested in joining the Simply Healthcare Plans, Inc. (Simply) network. Healthcare facility administratorswhether they work for a small family practice or a large hospital in a metropolitan cityshould also understand the benefits of efficient provider enrollment, as well as the possible consequences of failing to enroll properly. For these reasons, provider enrollmentwhile a complex and time-consuming processshould be in the forefront of your priorities. is the number one solution to healthcare contracting management. During the time that the five physicians worked and were not yet credentialed and contracted as in-network providers, your clinic would receive zero reimbursement for the patient care services rendered. Furthermore, you can find the "Troubleshooting Login Issues" section which can answer your unresolved problems and . Where? That doesnt always mean choosing the largest network either. https://nationalcredentialing.com/what-is-provider-enrollment/#:~:text=Provider%20Enrollment%20(or%20Payor%20Enrollment,inclusion%20in%20their%20provider%20panels.&text=Most%20commercial%20insurance%20networks%20have,separate%20from%20the%20credentialing%20step. People who carry that insurance are also more likely to seek out your practice if you are listed on the insurance companys website as a preferred provider. If you want to start earning more and worrying less. Because the process can take months, you should be certain that your provider application is justified. Staff will design, develop, and implement solutions for provider regulation compliance through close coordination with the Centers for Medicare and Medicaid Services, the Office of the Inspector General, and Medicaid Program Integrity, and other states' Medicaid programs; coordinate with internal and external partners in support of the Medicaid Enterprise System and operational processes; participate in development and implementation of system enhancements through close working relationship with the fiscal agent; represent the Agency on national meetings and work groups related to provider screening; develop operational process standards through process mapping; develop reporting mechanisms to manage Provider Enrollment Unit workloads and data anomalies; document regulatory requirements and proof of compliance; provide transparency to Provider Enrollment Unit activities; assist Medicaid Policy and Publication Units with maintenance of provider guides, training materials, and rule documents; and design, develop, and implement fiscal agent monitoring processes and reporting mechanisms in support of contract enforcement, including the use of CAPs and sanctions to enforce compliance. HealthSun Health Plans is an HMO plan with a Medicare Contract. {{content["mainL"]}} 305-234-9292 {{content["tollFreeL"]}} 877-207-4900 {{content["MemberServicesTollFree"]}} 877-336-2069 {{content["ttyL"]}} 877-206-0500 NOTE: Assignment of a Medicaid ID does not guarantee a place in the network of any health plan. How to Create Positive New Habits in our New World, Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, Disclosure of Ownership Form (PDF)- facilities, Overview of Billing Guidelines for Medical Foster Care Services (PDF), Add practitioners to your participating location by downloading the required forms listed, complete andsubmit to, Call Provider Services at 1-844-477-8313 or Fax 1-866-614-4955with questions about claims, credentialing or network status, A comprehensive approach to care for your patients through disease management programs, healthy behavior incentives and 24-hour toll-free access to bi-lingual registered nurses, Initial and ongoing provider education through orientations, office visits, training and updates, A dedicated claims team to ensure prompt payment, Minimal referral requirements and limited prior authorizations, A dedicated provider relations team to keep you informed and maintain support in person, by email or by phone, The ability to check member eligibility, authorization and claims status online, Healthcare collateral for your patients (e.g., information about our benefits and services) and educational displays for your office. To request release of such information, a written request must be submitted to the CredentialingDepartment at the address or email noted below. Onsite visits, proof of education, training and work history will remain with the health plans along with any additional criteria as determined by the plans. Ancillary (AAC, ASC, Cochlear Implant, Dialysis, DME, Hospitalist . As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services. 4 Tips for Accelerating Provider Enrollment. The Benefit of Provider Enrollment for Administrators, However, if these five physicians fail to submit their provider enrollment applications on time, or make common mistakes during the credentialing process, or face delays in the negotiation phaseyour clinic could face substantial losses. You should review and consider these materials at your own risk, and they should not be considered as client advice. Our credentialing department is headed by Michelle Graham a credentialing and provider enrolment specialist with 50+ years of experience. Annual Medical Record Reviews - ensures Providers' processes and practices meet privacy and medical record keeping standards; Accessibility - ensures Members have access to needed services according to Carisk's standards for outpatient appointments; Infrastructure - provides a system for coordinated care plans as well as a strong . If you are a non-contracted provider, please submit a request to join our network. Medicare Advantage: 1-844-405-4297, Medical Policies and Clinical UM Guidelines, Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment, A coordinated approach to care with innovative patient outreach/education, Patient centered medical home transformation, Online self-service tools and live-agent support, Local Provider Relations staff committed to your success. We are excited that you selected our provider network as your network of choice and look forward to assessing your Network Participation Request. The benefit information provided is a brief summary, not a complete description of benefits. By meeting the additional credentialing elements included within the Limited Enrollment process (such as background screening), providers may experience additional efficiencies when seeking credentialing by health plans. Doing any of the above can cause major delays, or even prevent you from joining the insurance panel. Upon receipt of this information, the provider or practitioner will have 21 days to provide a written explanation detailing the error or the difference in information to Sunshine Health. Health Plans. This caused lots of headaches and wasted time for providers, who were forced to tailor their applications for each specific payer. Provider Services: 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: 305-234-9275: Hours of Operation. Contact the Provider Enrollment Contact Center for additional assistance at 1-800-289-7799, option 4. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Sunshine Health is a managed care plan with a Florida Medicaid contract. Enrollment in HealthSun Health Plans depends on contract renewal. Open 8 a.m. to 8 p.m. 7 days a week, including holidays. Download the free version of Adobe Reader. Later, the costs of services are supposed to be reimbursed by patients insurance companies. Every year, Medicare evaluates plans based on a 5-star rating system. HealthSun Health Plans is an HMO plan with a Medicare Contract and a Medicaid contract with the State of Florida Agency for Health Care Administration. Requests should be submitted to the address noted below, or by calling Provider Services at 1-844-477-8313. Create your signature and click Ok. Press Done. Responsible for assisting plans and providers with the provider enrollment process, both initial and renewal; submitting provider maintenance to the Medicaid fiscal agent; receiving, tracking, and monitoring escalated issues, legislative requests, and public records requests; performing onsite reviews; coordinating and delivering plan and provider trainings related to provider enrollment; providing support for new plan enrollments under SMMC procurement, and coordinating with external agencies, including APO and DOH, regarding provider enrollment. HealthSun complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age . You dont want to end up missing reimbursement payments and facing severe financial losses. However, this does not include the release of references, recommendations or other information that is peer review protected. Provider Services: 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: 305-234-9275: Hours of Operation. 222 West Las Colinas Boulevard Suite 500N Irving, Texas 75039 214.574.3546 Providers who wish to submit claims directly to Florida Medicaid for fee-for-service reimbursement should apply for Full Enrollment. . Call HealthSun Health Plans at 1-877-336-2069 (TTY 1-877-206-0500). Provider Directory - Your South Florida Medicare Provider Health (1 days ago) You can request a hard copy of the Directory to be mailed to you at any time by calling our Member Services Department at 877-336-2069. This caused lots of headaches and wasted time for providers, who were forced to tailor their applications for each specific payer. Successfully obtaining a Limited Enrollment status with Medicaid may eliminate the need for providers to undergo the basic credentialing with each plan with which they seek to contract and may reduce the time it takes for a plan to complete credentialing with a health plan. (. For those providers of services solely to recipients in a health plan, Limited Enrollment is a valuable option. https://medconverge.com/difference-between-provider-credentialing-and-provider-enrollment/, https://www.caqh.org/type/membershipparticipant-list. Selected our provider network as your network Participation request ERA enrollment Available on November 8, 2021 credentialing beyond is But can choose to go through the Limited enrollment application, provider enrollmentwhile complex. > < /a > Contact the provider enrollment Contact Center for additional assistance at,. 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