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Recursos para proveedores | Ambetter de Sunshine Health
Recursos para proveedores
Need Help?
Learn how Provider Engagement can help you. To find your Provider Engagement Account Manager (PEAM), select this link:
Ambetter brinda las herramientas y apoyo que usted necesita para dar atención de la mejor calidad.
Call Provider Services For Help
If you need help, call Provider Services at 1-877-687-1169 (Retransmisión de 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 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