Pre-Auth Check
Use our tool to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can access our login to submit online.
- Medicaid, Serious Mental Illness & Child Welfare
- Children's Medical Services Health Plan
- Ambetter (Marketplace)
Prior Authorization
Send request to our Utilization Management Department
Medicaid
- Inpatient Prior Authorization Fax Form (PDF)
- Medicaid Outpatient Prior Authorization Form (PDF)
- Durable Medical Equipment Home Health and Home Infusion Referral Form (PDF)
Behavioral Health
- Behavioral Health In Lieu of Services Fax Form (PDF)
- Mental Health Residential Treatment or Partial Hospitalization Program Initial Request Form (PDF)
- Mental Health Residential Treatment or Partial Hospitalization Program Continued Stay Request Form (PDF)
- Outpatient Community Based Services Fax Form (PDF)
- Outpatient Electroconvulsive Therapy Fax Form (PDF)
- Outpatient Intensive Outpatient Therapy Fax Form (PDF)
- Outpatient Therapy Fax Form (PDF)
- Outpatient Psychological Testing Fax Form (PDF)
- Statewide Inpatient Psychiatric Program / Residential Treatment Center Authorization Form (PDF)
- Substance Abuse Disorder Residential or Partial Hospitalization Initial Request Fax Form (PDF)
- Substance Abuse Disorder Residential or Partial Hospitalization Extended Stay Request Fax Form (PDF)
Sunshine Health must approve in advance the services listed below. Prior approval is required for all services by a provider who is not in the Sunshine Health network. The only exception is for emergency care. Emergency room or urgent care visits do not require prior authorization. This list of services below is not all inclusive. Please call our Provider Services help line at 1-844-477-8313 to check if a prior authorization is required or use our online prior authorization look up tool.
Services Requiring Prior Authorization
PCPs, Specialists, or Facilities must request an authorization for the following services. Expand the links below to find out more information.
Inpatient Services
Post emergency stabilization, if applicable, for all acute and non-acute inpatient facility admissions, including: observations, inpatient hospice, behavioral health, crisis stabilization, detoxification, skilled nursing facility, crisis stabilization and rehabilitation.
Timeframes for notification are:
- 7 days prior to a scheduled or elective admission
- Within 48 hours of an emergency admission
- By next business day for a delivery
Ancillary Services
- Air transport
- Durable Medical Equipment and Prosthetics (list of codes on Sunshine Health’s website)
- Genetic Testing
- Home health and home infusion (initial nurse evaluation visit does not require a prior authorization)
- Home visit by a clinical social worker
- Occupational, physical, or speech after initial evaluation:
