Mandatory Specialty Network for Sunshine

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Effective April 1, 2015 American Therapy Administrators of Florida/Health Network One (ATA-FL/HN1) will be the mandatory specialty network for physical therapy, speech therapy and occupational therapy services provided in a free-standing outpatient setting (i.e. POS 11, 49), for Sunshine Health’s MMA and Child Welfare enrolled members. ATA-FL/HN1 does not cover services provided to members enrolled in the Early Steps Program or members who are receiving services in a Prescribed Pediatric Extended Care (PPEC) location. Please contact Sunshine Health directly for any questions that you may have regarding these programs.

Continuation of Care (COC)

If you are currently treating a Sunshine Health enrolled member you should continue to see the member for the duration of the member’s Continuation of Care (COC) period, which is up to 90 days from the April 1st 2015 for Child Welfare members and up to 60 days from April 1st 2015 for MMA members. You are not required to obtain an authorization from ATA-FL/HN1 to continue providing these services.

Claims Submission

Please submit your paper claims to HN1/ATA-FL at PO Box 21607, Fort Lauderdale, FL 33335-1607; or submit your Electronic Claims (EDI) via Payer ID 65064.

Along with your submittal of claims, Providers may be required to submit written documentation such as prior existing orders, prior authorizations and treatment plan/plan of care, in order to receive payment on their claim.

If you are NOT a participating provider with HN1/ATA-FL you must submit a W-9 with your claim(s) or you may fax your W-9 to ATA-FL/HN1 at 1-305-620-5973.

Transition of Care

If you are NOT a participating provider with HN1/ATA-FL, toward the end of the COC period, please refer the member to their Primary Care Physician, or Ordering Physician so that they may refer the member to a participating therapy provider. You may also contact Sunshine Health directly at 1-866-796-0530 or 1-855-463-4100 for Child Welfare member (TDD/TTY 1-800-955-8770), or you may contact ATA-FL/HN1 directly at 1-888-550-8800, Option 1, for assistance in transitioning the patient’s care.

If you have any questions regarding this communication, please contact ATA-FL/HN1’s Provider Relations Department at 1-888-550-8800, Option 2.

Sincerely,

Sunshine Health &
American Therapy Administrators of Florida/Health Network One