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Provider Resources, Manuals & Forms | Ambetter from Sunshine Health
Provider Resources
Need Help?
Learn how Provider Engagement can help you. To find your Provider Engagement Account Manager (PEAM), select this link:
Ambetter provides the tools and support you need to deliver the best quality of care.
Call Provider Services For Help
If you need help, call Provider Services at 1-877-687-1169 (Relay Florida 1-800-955-8770) Monday through Friday from 8 a.m. to 8 p.m. Eastern. Stay up to date on Ambetter from Sunshine Health provider notices by reviewing and bookmarking Provider News.
Provider Toolkit
We believe that delivering quality care doesn’t have to be complicated. So, to make working with us easier, we developed the Ambetter Provider Toolkit. It’s designed to provide you with valuable education and materials to simplify your administrative responsibilities—so you can focus on providing care.
Provider Forms
Training
Reference Materials
- 2026 Provider and Billing Manual (PDF)
- 2025 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- ICD-10 Information
- Payspan (PDF)
- Secure Portal (PDF)
- Telemedicine
- Referral and Authorization Information
- How to Secure Prior Authorization (PDF)
- Ambetter Health Hospital HH/DME Discharge Requirements QRG (PDF)
- Appointment Standards for Scheduling (PDF)
Medical Management
- Pre-Auth Needed?
- Prior Authorization Guide (PDF)
- Inpatient Prior Authorization Form (PDF)
- Outpatient Prior Authorization Form (PDF)
- Outpatient Prior Authorization Requirements (PDF)
- Grievance and Appeals
- Prior Authorization Request Form for Non-Specialty Drugs (PDF)
- Prior Authorization Request Form for Specialty Medication (PDF)
- Notification of Pregnancy Form (PDF)
- Risk Adjustment Coding Guidelines
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Supplemental Outpatient Authorization Form (PDF)
Site of Care Optimization Program
Our Site of Care program focuses on patients receiving infusion therapies or specialty drugs in high-cost setting, such as hospitals. The goal is to transition eligible patients to clinically appropriate lower-cost alternatives — like home infusion or freestanding infusion centers — when suitable. Learn more about the Site of Care program.
Resources
- Infusion Therapy Site of Care Optimization Clinical Policy (FL.CP.PHAR.493) (PDF)
- Prescriber Quick Reference Guide: Site of Care Redirection (PDF)
- Site of Care Optimization Program Frequently Asked Questions (FAQs) (PDF)
Infusion Providers
| Provider Name | Services Offered | Phone Number | Fax Number | Nursing Services |
|---|---|---|---|---|
| AcariaHealth | Home | 855-535-1815 | 855-217-0926 | Yes |
| Accredo | Home or AIS | 888-773-7376 | 407-852-4926 | Yes |
| KabaFusion Boca Raton | Home or AIS | 877-309-2207 | 877-309-2209 | Yes |
| KabaFusion Orlando | Home or AIS | 800-421-5596 | 407-425-7445 | Yes |
| OptionCare | Home or AIS | 844-672-4842 | 888-979-8904 | Yes |
| BioHealth | AIS | 786-4606044 | 786-219-3917 | No |
| Capstone Vital Care | Home or AIS | 407-992-8494 | 407-992-8495 | Yes |
| Vital Care Panama City | Home or AIS | 850-388-4333 | 850-388-4338 | Yes |
| Prosper Infusion | Home or AIS | 877-380-3131 | 813-922-2457 | Yes |
Use Find a Provider tool for full list of in-network providers.
Behavioral Health
- Discharge Consultation Form (PDF)
- Discharge Planner Checklist (PDF)
- SMART Goals Fact Sheet (PDF)
- OTR Tip Sheet (PDF)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Claims and Claims Payment
Standards for Appointment Scheduling
Quality
- Quality Improvement (QI)
- Child and Adolescent Well Care Visits (WCV) (PDF)
- Practice Guidelines (PDF)
- Appropriate Treatment for Upper Respiratory Infection (URI) (PDF)
- Appropriate Testing for Pharyngitis (CWP) (PDF)
- Use of Imaging Studies for Low Back Pain (PDF)
- Pediatric HEDIS Measures (PDF)
- Providing Quality Care