Sunshine State Health Plan,
How To Submit Claims To Sunshine State Health Plan,
Claims may be submitted electronically through Sunshine Health’s secure provider portal and via EDI. Sunshine Health lists payer ID 68069. Official pages also…
Short answer
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…
Sunshine State Health Plan,'s reviewed provider guidance starts with this submission channel: Secure Provider Portal. Confirm the member plan and claim type before using a payer ID or paper 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
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Corrected claims or reconsiderations/claim disputes must generally be received within 90 days from the original explanation of payment or denial.
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A second-level reconsideration/claim dispute is available and must be received within 90 days of the first-level decision correspondence.
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Reconsiderations can be submitted via the Secure Provider Portal in response to an underpaid or denied claim.
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Claims-related appeals/complaints use the Provider Claim Adjustment Request Form per the provider support guide.
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
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Payer ID and EDI claims guidance | The website contains our electronic Billing Manual ... Sunshine Health’s Payer ID is 68069. | Official | high |
| Portal can manage claims and authorizations | Use the Secure Provider Portal to ... Manage claims ... Manage authorizations. | Official | high |
| Claim reconsiderations/disputes mail address | Submit claim reconsiderations or adjustments through our secure web portal or mail to: Sunshine Health, Attn: Adjustments/Reconsiderations/Disputes, PO Box 3070, Farmington, MO 63640-3823. | Official | high |
| Portal claim-status and reconsideration functions; requirements | Provider Services ... Secure Provider Portal ... General claim inquiry; Check claim status; Claim reconsideration. | Official | high |
| Corrected claims and disputes timing | All requests for corrected claims or reconsiderations/claim disputes must be received within 90 days from the date of the original explanation of payment or denial. | Official | high |
Last reviewed: March 27, 2026
Sources used: 4 official
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