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DSNP Billing for Medicaid-Covered Services

September 8, 2023

As a valued provider for Wellcare DSNP members (Medicare/Medicaid eligible), Wellcare and Sunshine Health are dedicated to ensuring your claims and prior authorization requests are processed timely and accurately.

To ensure your claim is routed appropriately for DSNP members, begin by verifying member eligibility in the FLMMIS, Florida Medicaid Managed Information System. If you see "Sunshine State Health Plan" listed as the Medicare primary, that means a member has Wellcare Medicare. Claims and prior authorization requests for Medicare/Medicaid covered services should be routed to Wellcare Medicare.

When the Medicare benefit has exhausted, the claim will automatically process through Sunshine Health for Medicaid-covered services.

Download the Wellcare Quick Reference Guide for details on claims submissions and prior authorizations.

If you have questions about this notice, please contact your Provider Engagement Administrator or call Wellcare Provider Services at 1-855-538-0454. Stay up to date on Wellcare provider notices by reviewing and bookmarking Bulletins.


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Last Updated On: 9/8/2023
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.