Important Prior Authorization Updates

Date: 09/16/25

(Effective Oct. 15, 2025)

Thank you for being a participating provider with Ambetter Health. As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, we want to share some important updates to our PA requirements. This work is aligned with broader industry efforts, driven by commitments to regulatory agencies and America’s Health Insurance Plans (AHIP), to modernize and streamline prior authorization. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

A full list of code changes for Ambetter Health (Marketplace) can be found on our website at AmbetterHealth.com/flprovider. These changes may include:

• Removing PA requirements based on criticality of review and clinical need.
• Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests. 

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative or contact Ambetter Health Provider Services at 1-877-687-1169.                                                      

Questions?

Ambetter Health has a wealth of resources available to help answer your questions and address your concerns:

• Provider Support: Finding the Right Contact
• Provider Services: Call 1-877-687-1169
• Secure Provider Portal: Visit Provider.SunshineHealth.com to check member eligibility, submit claims and more.
• Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
• Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
• Provider News: Bookmark Ambetter Health Provider News and Sunshine Health Provider News to keep up with the latest updates.
• Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
• Provider Resources: Visit Ambetter Health Provider Resources to find provider manuals, important forms, scheduling standards and other provider resources.