Sunshine Health provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.sunshinehealth.com/providers/resources.html |
|---|---|
| Payer contact reference | 1-866-796-0530 |
| Claims payer ID | 68069 is published for 837 claims in the reviewed provider resources. Verify the member product and responsible service administrator; this does not establish eligibility or ERA routing. |
| Eligibility payer ID | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| ERA payer ID | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| Timely filing | Participating initial claims: 180 days |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- The reviewed reference distinguishes initial claims at 180 days for participating providers and 365 days for nonparticipating providers. Confirm product, contract, start event and exceptions; COB and reconsideration use separate rules.
- This registry has not established a payer-specific appeal ladder for Sunshine Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Sunshine Health at a glance
| Legal name | Sunshine State Health Plan, Inc. |
|---|---|
| Also known as | Sunshine State Health Plan, Ambetter Sunshine |
| Category | Medicaid MCO |
| Parent organization | Centene Corporation |
| Claims payer ID | 68069 is published for 837 claims in the reviewed provider resources. Verify the member product and responsible service administrator; this does not establish eligibility or ERA routing. |
| Eligibility (270/271) payer ID | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Florida |
| Members covered | ~1.9 million members |
| Provider resource entry point | https://www.sunshinehealth.com/providers/resources.html |
| Provider phone | 1-866-796-0530 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Sunshine Health
The reviewed reference distinguishes initial claims at 180 days for participating providers and 365 days for nonparticipating providers. Confirm product, contract, start event and exceptions; COB and reconsideration use separate rules.
| Submission type | Window |
|---|---|
| Initial claim reference | Participating initial claims: 180 days |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Sunshine Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Sunshine Health provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Sunshine Health
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Sunshine Health electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Sunshine Health. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Sunshine Health
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Sunshine Health volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 68069 is published for 837 claims in the reviewed provider resources. Verify the member product and responsible service administrator; this does not establish eligibility or ERA routing. |
| 270 / 271 eligibility | Listed in registry; verify current scope | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 68069 — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Claims routing evidence does not independently verify eligibility, ERA enrollment, or X12 278 support. Confirm each transaction separately.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
payer_ids.claims / electronic_claims_supported
Source comparison: 2026-09-26
Provider resources document 837 claims with payerID68069.
Primary source for payer_ids.claims / electronic_claims_supportedtimely_filing_days
Source comparison: 2026-09-26
The current general QRG table separates initial claims: participating 180 days, non-participating 365 days. COB and reconsideration have distinct clocks; 180 is not universal.
Primary source for timely_filing_daysportal_url
Source comparison: 2026-09-26
The existing provider-resources URL is a current provider resource with billing instructions and secure-login navigation.
Primary source for portal_url
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; provider_phone / payer_ids.eligibility / payer_ids.era / era_payer_id / supports_279_271 / supports_278: A claims payerID and online tools do not establish all transaction IDs/capabilities; this pass does not approve one phone role across products..
Sources used for this guide
State coverage
Sunshine Health operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Sunshine Health
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Sunshine Health; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Sunshine Health; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Sunshine Health before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Sunshine Health
Where is the Sunshine Health provider portal?
Use https://www.sunshinehealth.com/providers/resources.html as a starting point for Sunshine Health provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Sunshine Health?
The reviewed reference distinguishes initial claims at 180 days for participating providers and 365 days for nonparticipating providers. Confirm product, contract, start event and exceptions; COB and reconsideration use separate rules.
What is the Sunshine Health payer ID?
Claims: 68069 is published for 837 claims in the reviewed provider resources. Verify the member product and responsible service administrator; this does not establish eligibility or ERA routing.. Eligibility (270/271): 68069 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 68069 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Sunshine Health accept electronic claims?
Verify Sunshine Health electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Sunshine Health denial?
This registry has not established a payer-specific appeal ladder for Sunshine Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Sunshine Health prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Sunshine Health provider phone number?
This registry lists 1-866-796-0530 as a contact reference for Sunshine Health. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
Automate workflows around Sunshine Health requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Sunshine Health's current published documents before submission. CPT® is a registered trademark of the American Medical Association.