How To Submit Claims To Sunshine State Health Plan,

For Sunshine State Health Plan,, the practical claims workflow usually starts with electronic submission guidance and only falls back to paper instructions when the payer documents a mailing address for specific claim types or exceptions. The details below keep the workflow broad instead of reducing it to a single address.

At a glance

• Claims may be submitted electronically through Sunshine Health’s secure provider portal and via EDI. Sunshine Health lists payer ID 68069. Official pages also indicate paper/mail routes for reconsiderations/disputes and claim-adjustment complaints, but a single universal paper claims mailing address was not clearly identified on the reviewed pages. The portal is repeatedly presented as the self-service channel for claims inquiry, claim status, and reconsideration.

Submission channels

• Secure Provider Portal
• EDI
• Mail for reconsiderations/adjustments/disputes
• Phone/provider services for guidance

Electronic claims payer IDs

• 68069

Paper claims addresses

• Sunshine Health, Attn: Adjustments/Reconsiderations/Disputes, PO Box 3070, Farmington, MO 63640-3823

Corrected claims and follow-up

• Corrected claims or reconsiderations/claim disputes must generally be received within 90 days from the original explanation of payment or denial.

• A second-level reconsideration/claim dispute is available and must be received within 90 days of the first-level decision correspondence.

• Reconsiderations can be submitted via the Secure Provider Portal in response to an underpaid or denied claim.

• Claims-related appeals/complaints use the Provider Claim Adjustment Request Form per the provider support guide.

• Claims status resource 1

• Claims status resource 2

Caveats

• The reviewed pages did not provide one definitive universal paper claims mailing address for all claim types; only mail addresses for reconsiderations/disputes and complaints were found.
• Sunshine Health may have different workflows by product/line of business.
• Some pages direct providers to Availity or the portal; others mention Sunshine Health’s secure portal specifically.

Provider resources

• Sunshine Health Provider Portal & Resources (official)
• Florida Provider Resources | Florida Medicaid | Sunshine Health (official)
• General Quick Reference Guide for Providers (official)
• Provider Support Guide (official)
• Contact Us (official)
• Provider Complaints (official)

Sources