Effective July 1, 2025, separate reimbursement may not be used for claims that have been identified as readmission to the same hospital within 30 days of discharge for the same, similar, or related condition unless provider, federal, or CMS contracts and/or requirements indicate otherwise. For policy details, refer to the Provider Manual 2025

HS Bulletin Readmission (opens in a new window)

Effective January 1, 2025, HealthSun Health Plans, Inc. (HealthSun) will change its process for approving members for special supplemental benefits for the chronically ill (SSBCI), such as groceries, utilities, chronic meals (for more than 90 days), and nonemergency transportation to non-health-related destinations..

Special Supplemental Benefits for the Chronically Ill (SSBCI) Eligibility Changes Bulletin (opens in a new window) Special Supplemental Benefits for the Chronically Ill (SSBCI) HealthSun Provider Form (opens in a new window) Requesting SSBCI Referral - PCP (opens in a new window) Requesting SSBCI Referral - Specialist (opens in a new window) Social Services Referral (opens in a new window) Social Services Bulletin (opens in a new window)

As previously communicated, starting on 08/07/2024, HealthSun will implement a new procedure for the issuance of pre-certification approval and denial notifications. We will transition away from mailing physical approval and denial letters to instead issuing the notifications via fax to all providers and facilities. Member notifications will not be impacted. This change is being made to provide more timely approval and denial notifications to providers and institute a more efficient process overall. We believe this improvement will expedite the notification process. If you have any questions or concerns, please contact us at (877) 999-7776. Monday- Friday, 8:00AM to 5:00pm.

Shift to Fax for Pre-Certification Approval Notifications Notice July 11, 2024 (opens in a new window)

Chronic Care Snp Post Enrollment Qualification Form

2024 CSNP_VerLetter A Fillable English (opens in a new window) 2024 CSNP_VerLetter A Fillable Spanish (opens in a new window)

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

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 (opens in a new window) EnrollSafe EFT (opens in a new window)

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

DSNP Provider Training (opens in a new window) DSNP Provider Training Attestation (opens in a new window)