Forms & Documents for Providers
Now Available
Dual Eligible Special Needs Plan (D-SNP) Model of Care Training & Medicare Compliance Program Guidelines
Provider Notices and Updates
Provider Announcements
- *New Behavioral Health vendor effective 03/01/2023
- 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
- Notice of Health Plan Accreditation Survey - January 10th to January 12th, 2022
- Provider Manual 2023
- Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries
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
- 2023 Step Therapy Criteria Part B Drugs only – effective 01/01/2023
- Functional Mobility Evaluation Form (FME)
- OTC - Placing OTC Orders 2023
- Participating Provider Dispute Form
- Plan Of Care Form (POC)
- Pre-Cert Form
- Provider Appeal/Dispute Form
- 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. Every year, Medicare evaluates plans based on a 5-star rating system. Star rating is for contract years 2018, 2019, 2020, 2021, 2022 and 2023. HealthSun complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-336-2069. (TTY: 1-877-206-0500). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-877-336-2069. (TTY: 1-877-206-0500).
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.
H5431_WEB_M Last Updated On 04/28/2023