Sunshine Health and Staywell Integration Provider Resources

We have outlined some Frequently Asked Questions (FAQs) below regarding this change and how it affects you, our participating ATA-FL therapy provider.

1. Will ATA-FL continue to administer free standing facility physical therapy, speech therapy and occupational therapy services for Sunshine Health members after Oct. 1, 2021?

Yes. ATA-FL has been selected to continue to administer therapy services for members ages 3 and above enrolled in Sunshine Health as of Oct. 1, 2021.

2. What products are covered under this arrangement?

  • MMA – Medicaid
  • SMI – Serious Mental Illness Specialty Plan – NEW as of Oct. 1, 2021
  • CW – Child Welfare Specialty Plan

3. What products and/or services are excluded under this arrangement?

  • Long-Term Care (LTC)
  • Medicare
  • Children’s Medical Services (CMS) Health Plan
  • Members ages 0-2 (Note: Members will be managed by ATA-FL on the date of their 3rd birthday)
  • Early Intervention Services (EIS)
  • Prescribed Pediatric Extended Care (PPEC)
  • Outpatient hospitals

4. How do therapy providers obtain authorizations for members’ ages 0-2 on or after Oct. 1, 2021?

Please submit your authorization request through Sunshine Health’s Secure Provider Portal: SunshineHealth.com/login

5. How do therapy providers obtain authorizations for members’ ages 3 and above on or after Oct. 1, 2021?

Participating ATA-FL therapy providers should continue to obtain authorizations via the ATA-FL Provider Web Portal at ataflorida.com/hs1portal/. If you are unable to submit via the portal, contact your Provider Relations Representative (referenced in FAQ #11). To reference full guidelines for authorization requests, please reference the Provider Resources page in the online ATA-FL Provider Manual: ataflorida.com/provider-resources.php

6. If I am not a provider with Sunshine Health today, but I see members ages 0-2, how do I become a participating provider to service this population?

Providers wishing to serve Sunshine members aged 0-2 can follow this link and then click the “Join Our Network” button: SunshineHealth.com/providers/become-a-provider.html. Sunshine Health will reach out to you regarding participation after you provide the requested information.

7. When a Staywell member, who has been authorized for services prior to Oct. 1, 2021, becomes a Sunshine Health member on Oct. 1, 2021 and is still in treatment (valid authorization) on that date, do I need to obtain a new authorization number?

Ages 0-2
No, you do not need to obtain a new authorization. If you are a participating provider with Sunshine Health, you may continue to treat former Staywell members through the end of the Continuity of Care (COC) period up to 120 days or through the expiration of the authorization, whichever comes first.

After the end of the COC period or the end of the authorization, whichever comes first, the provider must contact Sunshine Health via the Secure Provider Portal for additional authorizations: SunshineHealth.com/login..

If you are not a participating provider with Sunshine Health, the plan will need to determine if continuing the service is medically necessary. Please submit the request via the Sunshine Health Secure Provider Portal at SunshineHealth.com/login..

Ages 3 and above
No, you do not need to obtain a new authorization. As a participating ATA-FL therapy provider, you may continue to treat members through the end of the COC period up to 120 days, or through the expiration of the authorization, whichever comes first. Claims may be submitted to ATA-FL for services on or after Oct. 1, 2021. If the member requires treatment after the COC period or the end of their authorization period, whichever comes first, you may follow the normal authorization request process with ATA-FL.

8. For Staywell members who become Sunshine Health members on Oct. 1, 2021, where do ATA-FL therapy providers submit claims for dates of service rendered on or after Oct. 1, 2021 during the COC period?

Ages 0-2
Claims for members aged 0 – 2 should be submitted to Sunshine Health. Follow the normal claims submission guidelines as documented in the Sunshine Health Provider Manual: SunshineHealth.com/providers/resources/forms-resources.html.

Ages 3 and above
Follow the normal claims submission guidelines as documented in the ATA-FL Provider Manual ataflorida.com/provider-resources.php.

9. If an existing Sunshine Health member has been authorized for services by ATA-FL and is still in treatment with a valid authorization on Oct. 1 2021, do I need to obtain a new authorization number?

Ages 0-2
No, you do not need to obtain a new authorization. If you are a participating provider with Sunshine Health, you may continue to treat Sunshine Health members through the end of the COC period up to 120.

After the end of the COC period or the end of the authorization, the provider must contact Sunshine Health via the Secure Provider Portal for additional authorizations: SunshineHealth.com/login.

If you are not a participating provider with Sunshine Health, the plan will need to determine if continuing the service is medically necessary. Please submit the request via the Sunshine Health Secure Provider Portal: SunshineHealth.com/login.

Ages 3 and above
No, you do not need to obtain a new authorization. As a participating ATA-FL provider, a new authorization is not required. COC guidelines would not apply.

10. If an existing Sunshine Health member has been authorized for services prior by ATA-FL and is still in treatment with a valid authorization on Oct. 1 2021, where do I submit claims for dates of service rendered on or after that date during the COC period?

Ages 0-2
Claims for member ages 0 – 2 should be submitted to Sunshine Health. Follow the normal claims submission guidelines detailed in theSunshine Health Provider Manual

Ages 3 and above
COC guidelines would not apply. Follow the normal claims submission guidelines as documented in the ATA-FL Provider Manual: ataflorida.com/provider-resources.php .

If a member turns age 3 during active treatment with an open authorization with Sunshine Health, claims should be submitted to Sunshine Health until that authorization expires.

11. How may I contact an ATA-FL representative in my area?

Call ATA-FL at 1-888-550-8800 and enter the extension of the representative below in your area; you may also dial the toll-free number and select Option 2 to speak with an in-house Provider Relations Representative.

  • Regions 1, 2, 3, 5: Rosanna Briggs, Ext: 4215
  • Region 4 and Seminole, Orange, Brevard, Indian River, Okeechobee, St. Lucie and Martin counties: Paula Powell, Ext: 4711
  • Regions 6, 8 and Osceola and Palm Beach Counties: Ana Rios, Ext: 4604
  • Regions 10, 11: Luis Martinez, Ext: 4223

To find the region you are in, you may access a FL Medicaid Regions map by clicking on the link.