Manuals, Forms and Resources

The Medicaid In Lieu of Services Resource Guide describes the ILOS benefits, eligibility requirements, limits and prescribing rules.

Claims Related Forms

• Provider Dispute Form (PDF)
• W-9 Form (PDF)

General Provider Forms

• File A Complaint
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Supplemental Outpatient Authorization Form (PDF)
• Connections Referral Form (PDF)
• Prior Authorization List
• Provider Education – Marketing (PDF)
• Risk Adjustment (PDF)
• Durable Medical Equipment Home Health and Home Infusion Referral Form (PDF)
• Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian (PDF)

BMI Graph Tool

PaperFree Florida

• PaperFree Florida Brochure (PDF)
• Get the Facts About Regional Extension Centers (PDF)

Training

• Early Intervention Services and Targeted Case Management for children ages 0 to 3 (PDF)
  • EIS and TCM Billing Tip Sheet (PDF)
  • PaySpan Registration Instructions (PDF)
  • Medical Foster Care billing and reimbursement guidelines overview (PDF)
  • How to Apply for Your NPI Number (PDF)

  Children's Medical Services (CMS) Health Plan

  General Provider Forms

  • Outpatient Prior Authorization Fax Form - Children's Medical Services Health Plan (PDF)
  • Supplemental Outpatient Authorization Form (PDF)

  Medicare (Wellcare)

  Provider Manuals and Guides

  • Provider and Billing Manual - Medicare Advantage (PDF)
  • Quick Reference Guide (PDF)

  Claims and Payments

  Billing

  • PaySpan – EFT/ERA
    Allwell from Sunshine Health is pleased to partner with PaySpan Health to provide an innovative web based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). This service is provided at no cost to providers and allows online enrollment.
    Visit PaySpan’s website for more information
  • Provider Portal
    If you are a contracted provider, you can register now. View detailed instructions on how to register (PDF). If you are a non-contracted provider, you will be able to register after you submit your first claim.
  • Sunshine Health Payment Policies

  Provider Payment forms

  • Provider Dispute Form (PDF)
  • W-9 Form (PDF)

  Medical Management

  Prior Authorization Resource

  Medicare Pre-Auth Disclaimer: All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent upon eligibility, covered benefits, provider contracts and correct coding and billing practices. For specific details, please refer to the Allwell from Sunshine provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

  Authorization Forms

  Authorization requests may be submitted by secure web portal and should include all necessary clinical information.

  • Medicare Advantage Prior Authorization List - English (PDF)
  • Medicare Advantage Prior Authorization List - Spanish (PDF)
  • Supplemental Outpatient Authorization Form (PDF)
  • Durable Medical Equipment (DME), Home Health & Home Infusion Referral Form (PDF)
  • National Imaging Associates (NIA)