Provider Portal

Shift to Fax for Pre-Certification Approval Notifications Notice July 11, 2024

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

CHRONIC CARE SNP POST ENROLLMENT QUALIFICATION FORM

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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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
Ideal Dental uses guidelines for dental requests than can be accessed here.
Ideal Dental Medicare Authorization and referral Guideline

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