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Provider enrollment doesnt have to be such a painstaking process. Along with Medicaid, Tricare, and other governmental health programs, Medicare has its own standard forms that must be filled out and sent to the government representatives in your community. 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. When trying to enroll as a provider with Medicare, its best to seek the support of someone who is specifically familiar with the Medicare provider enrollment regulations. HealthSun Health Plans is an HMO plan with a Medicare Contract. https://www.veritystream.com/resources/details/blog/2018/12/19/4-tips-for-accelerating-provider-enrollment. If you are not contracted with Sunshine Health, complete the Network Participation Request Form below. 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. HealthSun complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age . Its important to keep in mind that the average healthcare provider works with not just one, but 25 payers.2 That means a lot of paperwork to keep track of and many opportunities for small but significant errors. Responsible for the business of provider enrollment. For those providers of services solely to recipients in a health plan, Limited Enrollment is a valuable option. Registered providers are not required to seek Limited Enrollment but can choose to go through the Limited Enrollment process. For more information contact the Managed Care Plan. Healthcents coordinates with payers so that you can focus on delivering the best care to your patients. Providers themselves are not the only people who need to take the provider enrollment process seriously. 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. Enrollment in HealthSun Health Plans depends on contract renewal. LoginAsk is here to help you access Healthsun Provider Portal Login quickly and handle each specific case you encounter. If you want to start earning more and worrying less, contact us today. Contact the Provider Enrollment Contact Center for additional assistance at 1-800-289-7799, option 4. During the credentialing and re-credentialing process, Sunshine Health will obtain information from various sources to evaluate applications. Provider Portal The benefit information provided is a brief summary, not a complete description of benefits. Its important to understand which health insurance plans are most popular among the people in your community so that you can make an informed decision that most benefits your practice. With the implementation of Limited Enrollment in December 2015, providers seeking to participate in a health plans network have the option to utilize a web-based Limited Enrollment application wizard which guides them through creation of the application. Every year, Medicare evaluates plans based on a 5-star rating system. Our hours of operation are Monday through Friday, 8am to 8pm. Provider Services: 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: 305-234-9275: Hours of Operation. Provider Enrollment is comprised of three business teams, Plan and Provider Enrollment and Outreach, Provider Eligibility and Compliance, and Provider Business Module Management. Every year, Medicare evaluates plans based on a 5-star rating system. Limited Enrollment is an option for providers who will only be paid by a health plan. Provider enrollment, credentialing, and contract negotiation make up a very lengthy process. You need to have a primary location where you deliver patient care services, You must include banking information in your application so that you can receive EFT payments, which is how Medicare reimburses providers, Your application must include the personal information of every individual who has an ownership stake in your practice or facility, If you were born outside of the United States, you will need to provide citizenship documents with your application, How To Make the Provider Enrollment Process Easier. And remember: the average provider works with 25 payers! - HealthSun Health Plans EFT and ERA Enrollment Available On November 8, 2021 Enrollment for the services will begin November 8, 2021 . You can rely on state of the art techniques, tools, and data to ensure youre signing the best contracts with the right payers. Call us 8am - 8pm local time M-F. For Individual & Family plans, 833-356-1182 For Medicare Advantage plans, 844-667-5502 | TTY: 711 That doesnt always mean choosing the largest network either. . To the extent you desire to establish a consulting relationship with the Company and obtain tailored advice regarding your specific operations and potential revenue growth, please contact info@payrhealth.com. Choose My Signature. Because of this, the financial impacts of provider enrollment are numerous. Each plan may apply their own standards for provider credentialing beyond what is required by Medicaid. Provider Services: 877-999-7776: Member Services Toll Free: 877-336-2069: TTY: 877-206-0500: Fax: 305-234-9275: Hours of Operation. credentialed and contracted as in-network providers, your clinic would receive zero reimbursement for the patient care services rendered. The list of participating insurance companies who now use the CAQH application for provider enrollment includes: The provider enrollment process is different if you want to be able to accept Medicare. In the past, every insurance company had a unique provider enrollment process, meaning application forms and credentialing requirements varied from payer to payer. 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. 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: 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. Ancillary (AAC, ASC, Cochlear Implant, Dialysis, DME, Hospitalist . Additional information on provider enrollment can be found on the AHCA website. Providers that go through the Limited Enrollment process do not need to register. Registration should be reserved for the use of health plans to obtain Medicaid IDs for non-participating providers. 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. (. Successful provider enrollment helps you attract new patients, generate more revenue, and expand your practice or health care program. Please note, if you are a non participating provider, you are required to fill out the BA Agreement provided below. Yes. We are excited that you selected our provider network as your network of choice and look forward to assessing your Network Participation Request. TTY users should call 877-206-0500. Please select your primary service type: *. Provider Enrollment is responsible for enrolling qualified providers to receive Medicaid reimbursement for services rendered to Medicaid recipients. If the insurance company wants to move forward with your application, they will need to verify your competence, license and qualifications as a healthcare provider. 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. Our precertification, referrals, claims and payment processes are streamlined to help you focus on what you do best caring for your patients. Download the free version of Adobe Reader. These figures represent the length of the process when it moves along at an average paceit can take significantly longer if you make any errors along the way. 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. And to generate revenue, you need to have a list of patients who view your facility and care services as in-network.. There are three variants; a typed, drawn or uploaded signature. The provider enrollment process can be broken down into three phases: provider enrollment application, provider credentialing, and negotiation. Health Plans. Your South Florida Medicare Provider - HealthSun Health . As a Sunshine Health provider, you can rely on: You will need Adobe Reader to open PDFs on this site. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. The effects of provider enrollment can be felt across the entire organization. Every year . Call HealthSun Health Plans at 1-877-336-2069 (TTY 1-877-206-0500). Or send your request to info@healthsun.com. Sunshine Health is a managed care plan with a Florida Medicaid contract. With Healthcents, applications are quick and easy, and negotiations are handled by a team of experts so that you get the very best reimbursement rates. . We have a diverse network of exceptional health care professionals that help to ensure our members have uninterrupted access to the health care they need. You make your patients' lives better. Therefore, you can think of proper provider enrollment not only as something that adds value to your practice, but as a vital process that can prevent disaster. Consider, for example, that you work as an administrator at a local clinic that staffs five physicians. 1-888-950-1169. The provider and pharmacy network may change at any time. Our hours of operation are Monday through Friday, 8am to 8pm. Were glad to hear that you are interested in joining the Simply Healthcare Plans, Inc. (Simply) network. Create your signature and click Ok. Press Done. OR: 2. If you are a non-contracted provider, please submit a request to join our network. Decide on what kind of signature to create. 2121 Lohmans Crossing RdSuite 504-823Austin, TX 78734. If you want to start earning more and worrying less. The provider enrollment process can be broken down into three phases: provider enrollment application. 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. {{content["mainL"]}} 305-234-9292 {{content["tollFreeL"]}} 877-207-4900 {{content["MemberServicesTollFree"]}} 877-336-2069 {{content["ttyL"]}} 877-206-0500 This caused lots of headaches and wasted time for providers, who were forced to tailor their applications for each specific payer. Upon receipt of a Limited Enrollment application, AHCA will perform several basic credentialing functions, including licensure verification and review of background screening history, including criminal history and federal exclusion database checks. Furthermore, you can find the "Troubleshooting Login Issues" section which can answer your unresolved problems and . Healthsun Provider Portal Login will sometimes glitch and take you a long time to try different solutions. This verification process is commonly referred to as, Once the insurance company verifies that you are competent and qualified to provide patient care services, they will offer you a. Written inquiries will be sent back to the practitioner via Restricted Delivery Certified Mail within 14 days of the receipt of the request from the practitioner. To enroll with HealthSun Health Plans, you must have Medicare Part A and Medicare Part B and live in one of our covered service areas. That means a lot of paperwork to keep track of and many opportunities for small but significant errors. Enrollment in HealthSun Health Plans depends on contract renewal. We're glad to hear that you are interested in joining the Simply Healthcare Plans, Inc. (Simply) network. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. However, this does not include the release of references, recommendations or other information that is peer review protected. Follow the step-by-step instructions below to design your armed credentialing application form: Select the document you want to sign and click Upload. Later, the costs of services are supposed to be reimbursed by patients insurance companies. Preferred Medicare Assist Palm Beach (HMO D-SNP) 1-855-874-6282 (TTY 711) Preferred Medicare Assist Plan 2 (HMO D-SNP) Toll-Free. (And remember: the average provider works with 25 payers!). Enrollment in HealthSun Health Plans depends on contract renewal. Provider Enrollment Help Line Information Florida Medicaid's Web Portal solution provides communication and self-service tools to the provider community. The benefit information provided is a brief summary, not a complete description of benefits. NOTE: Assignment of a Medicaid ID does not guarantee a place in the network of any health plan. Sunshine Healths Credentialing Committee will then include this information as part of the credentialing /recredentialing process. You will need Adobe Reader to open PDFs on this site. As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services. 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. 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 . 4 Tips for Accelerating Provider Enrollment. You can rely on state of the art techniques, tools, and data to ensure youre signing the best contracts with the right payers. For more information contact the Managed Care Plan. Typically, beneficiaries cannot enroll in a Medicare Advantage Plan outside of the Open Enrollment Period. What Is Provider Enrollment Going To Do for Your Practice? Open 8 a.m. to 8 p.m. 7 days a week, including holidays. 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. 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. Because the process can take months, you should be certain that your provider application is justified. Requests should be submitted to the address noted below, or by calling Provider Services at 1-844-477-8313. View our Summary of Benefits for plans and service areas available to you. Limitations, co-payments and restrictions may apply. https://medconverge.com/difference-between-provider-credentialing-and-provider-enrollment/, https://www.caqh.org/type/membershipparticipant-list. By the same token, failure to perform the provider enrollment process successfully can cause massive financial losses, stall business, limit your ability to deliver the best patient care services to as many people as possible, and damage the reputation of your practice. Call HealthSun Health Plans at 1-877-336-2069 (TTY 1-877-206-0500). is the number one solution to healthcare contracting management. The streamlined application and corresponding review process allows approved providers to receive their Medicaid IDs faster than with traditional full enrollment. Difference Between Provider Credentialing and Provider Enrollment. Requests to release information are to be submitted directly to Sunshine Health, Attn: Credentialing Department at. The Company disclaims any liability with respect to the materials set forth herein. Every year . Credentialing alone often takes the insurance company up to 90 days, while the contract negotiation and finalization process can tack on another 30 to 45 days. Fee-for-service providers must seek traditional Full Enrollment in order to directly bill Medicaid for reimbursement. Not answering every question on the application in full detail, Using incorrect formats on application pages for things like phone numbers and dates, Failing to provide all of the requested documents, Providing incomplete documentation (for example, sending 2 references instead of 3), Using secondary source material instead of primary documents (for example, an unofficial medical school transcript), Doing any of the above can cause major delays, or even prevent you from joining the. The Limited Enrollment application captures all demographic information, licensure and exclusion databases verification and background screenings in compliance with Affordable Care Act provider screening requirements. Limited providers will be required to complete a renewal process every three years, similar to the current renewal process for Enrolled providers. Once all items have been filled out, please return to: providerservices@healthsun.com. Every year, Medicare evaluates plans based on a 5-star rating system. As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services. To avoid this, administrators can: The Council for Affordable Quality Health Care, or CAQH, is a nonprofit organization that presents a simpler solution to one aspect of the provider enrollment process. 222 West Las Colinas Boulevard Suite 500N Irving, Texas 75039 214.574.3546 Providers and practitioners have the right to review any primary source information that Sunshine Health collects during this process such as the National Practitioner Data Bank (NPDB), Licensing and Board Certification. Sunshine Health is a managed care plan with a Florida Medicaid contract. 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. A member of our team will contact you to relay if a decision is made to move forward with the contracting process within your region. No. In response to this problem, CAQH developed a universal application through which providers could upload all of their personal information and supporting documents. 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. Enrollment in HealthSun Health Plans depends on contract renewal. Below is a more detailed description of each of them. Where? To avoid this, administrators can: Stop viewing provider enrollment as a back office or behind the scenes task, Take a more active role in assisting providers with their applications, Reduce the time it takes to enroll providers by integrating with CAQH, In the past, every insurance company had a unique provider enrollment process, meaning application forms and credentialing requirements varied from payer to payer. Healthcents is the number one solution to healthcare contracting management. You dont want to end up missing reimbursement payments and facing severe financial losses. Our credentialing department is headed by Michelle Graham a credentialing and provider enrolment specialist with 50+ years of experience. For these reasons, provider enrollmentwhile a complex and time-consuming processshould be in the forefront of your priorities. To request release of such information, a written request must be submitted to the CredentialingDepartment at the address or email noted below. Provider enrollment, credentialing, and contract negotiation make up a very lengthy process. Enrollment in HealthSun Health Plans depends on contract renewal. The information provided by PayrHealth, LLC (the Company) on this website is informational in nature, and has not been tailored or modified to fit any particular set of facts. This quick guide will take a closer look at the significance of provider enrollment, how it relates to credentialing, and how to streamline the process for the benefit of your practice. Well be happy to talk with you about joining our Simply network. What provider credentialing functions will remain with the health plans? And take you a long time to try different solutions registration should be reserved for the patient care as... For these reasons, provider enrollmentwhile a complex and time-consuming processshould be in the forefront of your priorities Agreement! Order to directly bill Medicaid for reimbursement if you are not the only people who need to take provider. Enrollment but can choose to go through the Limited enrollment but can choose to go through the Limited but! And click Upload clinic that staffs five physicians that is peer review protected you want to start earning more worrying. 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