Provider Portal

CHRONIC CARE SNP POST ENROLLMENT QUALIFICATION FORM

Chronic Care Snp Post Enrollment Qualification Form

2024 CSNP_VerLetter A Fillable English 2024 CSNP_VerLetter A Fillable Spanish

Provider Payment Communication October 30, 2023

Dear Provider: We have identified discrepancies that may have affected your payment on the September 28, 2023 and October 2, 2023 claims check cycles. If you were affected on either check cycle, you will receive the balance due in the coming weeks. We apologize for any inconvenience this may have caused. If you have any questions, please contact our Provider Phone Inquiry unit at 877-999-7776, Monday through Friday, 8:00am to 5:30pm

EFT and ERA Enrollment Available On November 8, 2021

Enrollment for the services will begin November 8, 2021 . Our EnrollSafe EFT enrollment hub is easy, safe, secure and available 24-hours a day

Information on Enrollsafe EFT EnrollSafe EFT

Provider Trainings: Important

Dual Eligible Special Needs Plan (D-SNP) Model of Care Training & Medicare Compliance Program Guidelines

DSNP Provider Training DSNP Provider Training Attestation

Provider Compliance Alerts

Compliance is everyone’s responsibility. Our Provider Compliance Alerts provide information and reminders to HealthSun Providers. We highly recommend you to consult this site regularly for information on new Compliance Alerts and other information that will assist our providers in their compliance efforts.

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Provider Notices and Updates

We thank you for being part of our provider network and value your care and attention to our members. Attached you will find helpful information for you to explore.

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Portal Services and Tools

Member Information

View member information as shown on a member identification card, verify eligibility, as well as plan benefits.

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Claim Status

View status and payment information for a given claim.

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Explanation of Payments

View the explanation of payments for a check you've received.

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Member Roster

View and download a list of members associated with your location.

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View Referral

View and Search submitted referrals. Use our tool to search by referral number, member name, referral date, etc.

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Submit Referral

Submit referral requests

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Search ICD 10s

Search and view ICD 10 descriptions

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Export EOP EDI 835

Export EDI 835 by provider. Select from your list of authorized providers and click to download the edi 835 of your choosing.

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270/271 Companion Guide

HealthSun accepts and provides Healthcare Eligibility Benefit Inquiry and Response via a 270 and 271. For more information, please see attached companion guide.

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Admission Notifications

Search and view the Admission Notifications.

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HealthSun may use MCG criteria to make coverage decisions. To review MCG criteria, click the link below to go to MCG’s tool. After you click the link, follow the steps on the screen to access MCG criteria.
Medicare MCG Coverage Guidelines
HealthSun may also use medical policies and clinical guidelines used by an affiliated health plan, Simply Healthcare. Click the link below to review these guidelines.
Medical Policies and Clinical Guidelines
Florida Dental Benefits uses guidelines for dental requests that can be accessed here.
FDB Medicare Authorization and Referral Guidelines

Policies and Procedures

Information regarding Billing and Claims

Important Laboratory Notification

LabCorp Laboratories Information

CMS Bulletins

CMS Part D Opioid Prescriber Webinar 20181206 508

CMS PartD Opioid Prescriber Tip Sheet 20181206 508

Inappropriate billing for QMB beneficiaries