Forms & Documents for Providers
Now Available
Special Needs Plan (SNP) Model of Care Training & Medicare Compliance Program Guidelines
Special supplemental benefits for the chronically ill (SSBCI) Eligibility Changes
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
Special Supplemental Benefits for the Chronically Ill (SSBCI) HealthSun Provider Form
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.
Provider Notices and Updates
Provider Announcements
- *Shift to Fax for Pre-Certification Approval Notifications Notice July 11, 2024
- Attention HealthSun Providers, effective 01/01/2020, HealthSun will be changing to a new Pharmacy Benefit Manager (PBM)
- Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency
- New Behavioral Health vendor effective 03/01/2023
- Notice of Health Plan Accreditation Survey - December 4th to December 6th, 2023
- Provider Payment Notification 10/2023
- Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries
Archive
- Adult Elective Surgery and Procedures Recommendations
- Jimmo v. Sebelius Internal Training for Staff
- Long Term Care Facility Guidance
- New Medicare Part D Prescription Opioid Policies for 2019 (Prescriber Webinar)
- New Medicare Part D Prescription Opioid Policies for 2019 (Tip Sheet)
- Provider Manual 2023
HealthSun Health Plans FDR Compliance
HealthSun Health Plans FDR Compliance
Clinical Practice and Preventive Guidelines
Clinical Practice and Preventive Guidelines
Additional Provider Forms
Provider Forms
- 2024 Step Therapy Criteria Part B Drugs only – effective 10/01/2024
- Functional Mobility Evaluation Form (FME)
- OTC - Placing OTC Orders 2024
- OTC - Placing OTC Orders 2025
- Participating Provider Dispute Form
- Plan Of Care Form (POC)
- Pre-Cert Form
- Provider Manual 2024
- Specialty Medication Request Form
- Waiver of Liability Form
Provider Portal Access
To apply for access to the portal, please complete application provided below. Please note, if you are a non participating provider, you are required to fill out the BA Agreement provided below. Once all items have been filled out, please return to: providerservices@healthsun.com.
Provider Portal
Or consider these next steps:
Have questions? We’re here for you.
Call: 1.877.336.2069 TTY: 711 or write: info@healthsun.com
For more options and for hours of operation, visit our Contact page
HealthSun Health Plans is an HMO plan with a Medicare Contract and a Medicaid contract with the State of Florida Agency for Health Care Administration. Enrollment in HealthSun Health Plans depends on contract renewal. We do not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age, or disability in our health programs and activities. Hablamos español y podemos ayudarle a encontrar el plan ideal para usted. If you speak a language other than English, translation and alternate format services are available to you on a standing basis, free of charge. Just call 1-877-336-2069 (TTY: 711), 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.
Do you need to file a complaint? File your complaint online via CMS by submitting the Medicare Complaint Form. Should you need to file a complaint with Medicare you may do so by calling CMS at 1-800-Medicare.
You can report suspected fraud or any other non-compliance activity by calling our Member Services Department at 877-336-2069 or TTY at 877-206-0500.
Y0114_25_3013461_0000_U_M CMS Accepted 09/29/2024