Provider Service Authorizations

As you know, Staywell Health Plan is merging with Sunshine Health and the Children’s Medical Services Health Plan (CMS) will be operated by Sunshine Health, effective October 1, 2021.

Sunshine Health is working to transfer service authorizations for Staywell and CMS members into the Sunshine Health Secure Provider Portal.

• Any existing authorizations for Staywell and CMS members prior to September 30, 2021, will be honored and transferred to Sunshine Health.

Process for Submission of New and Renewal Authorizations

• For service authorizations or renewals completed on or before September 30, 2021, for Staywell and CMS members, providers should continue to utilize the fax forms found on the WellCare website or call Provider Services to submit authorizations:
  • Staywell authorizations: 1-866-334-792
  • CMS Health Plan authorizations: 1-866-799-5321

  Electronic Visit Verification

  Sunshine Health is loading Staywell and CMS member authorizations into our systems. We expect all authorizations and placements to be visible in providers’ HHAeXchange portal accounts by October 15, 2021.

  To ensure there are no disruptions in services or your ability to capture EVV compliant services, we are working with HHAeXchange to connect Staywell and CMS members to your Sunshine Health Provider Portal account. These placements will come over without an authorization, but we will provide the necessary information in HHAeXchange so you may schedule and confirm visits.

  Please note that visits in HHAeXchange without a supporting authorization will be pink, which means you will be unable to bill for services until the authorization from Sunshine Health has been loaded. Once authorizations have been loaded, previously confirmed visits will turn from pink to green and you will be able to bill for those visits. If you do not see a member in your portal, please reach out to Sunshine Health through the HHAeXchange Communications Message Center or contact your Provider Relations Representative.

  Learn More

  To view a copy of the letter Staywell members are receiving, visit SunshineHealth.com/Staywell. To view a copy of the letter Children’s Medical Services Health Plan members are receiving, visit SunshineHealth.com/CMS.

  Questions?

  Call Provider Services at 1-844-477-8313, Monday through Friday from 8 a.m. to 8 p.m. Eastern, or contact your Provider Relations Representative. Find your dedicated representative.