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Sunshine State Health Plan Claim Filing Instructions January Form
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People also ask
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Where do I mail my Sunshine State health plan claim?
How do I submit my claims? Providers submitting a claim to Sunshine Health for the first time should submit a paper claim to Sunshine State health Plan, PO Box 3070, Farmington, MO 63640-3823, ATTN: Claims Department.
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Can you submit paper claims to Florida Medicaid?
Sunshine Health utilizes the encounter reporting to evaluate all aspects of quality and utilization management, and it is required by the State of Florida and by Centers for Medicare and Medicaid Services (CMS). A claim is a request for reimbursement either electronically or by paper for any medical service.
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Can you bill a Florida Medicaid patient?
(c) Providers may bill a patient accepted as a Medicaid patient only in the following situations: (1) for allowable deductibles, co-insurance, or co-payments as specified in the Medicaid State Plan; (2) before the service or supply is provided, the provider has informed the patient that the patient may be billed for a ...
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How to claim Medicaid in Florida?
Applications for Florida Medicaid Waiver services (financial eligibility) are processed by the DCF. You may go to the DCF Public Benefits & Services website site or call DCF at 1- (866) 762-2237 for more information about Medicaid. All documents must be provided to DCF for financial eligibility determination.
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How to submit medical bills to Medicaid Florida?
Proof of medical expenses can be submitted by fax, mail, or in person. Be sure to include your name and case number on medical expenses.
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What is the timely filing limit for Florida Medicaid?
Exceptions to the 12-month claim submission time limit may be allowed, if the claim meets certain conditions. Providers must submit exceptional claims, along with the required Exceptional Claim Form, electronically via the Florida Medicaid Secure Web Portal under the Claims panel.
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Does Florida Medicare accept paper claims?
The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Providers meeting an ASCA exception may send their claims to Medicare on a paper claim form. (For more information regarding ASCA exceptions, refer to Chapter 24.)
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What is the timely filing limit for Sunshine State Health Plan corrected claims?
Corrected claims must be submitted within 180 days from the date of service. All claim requests for reconsiderations and claim disputes must be received within 90 days from the date of original notification of payment or denial was issued.
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