Health Plans

Ambetter from Sunshine Health

Welcome to the Ambetter from Sunshine Health page. Here you can download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and information designed to assist you in using the RadMD Website to obtain and check authorizations.

Effective January 1, 2021, Ambetter from Sunshine Health will expand its partnership with NIA to provide utilization management for outpatient rehabilitative and habilitative physical medicine services for Ambetter members only. Physical, occupational and speech therapy services provided on or after Jan. 1, 2021 will require prior authorization.

In addition, Effective January 1, 2021, Ambetter from Sunshine Health’s relationship with NIA will be expanding to include outpatient imaging services in expanded counties (see expanded county listing).

NIA manages non-emergent outpatient imaging procedures for Ambetter from Sunshine Health membership through NIA’s Free-Standing Imaging Facilities coupled with Ambetter from Sunshine Health in-office providers and hospitals.

If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager Andrew Dietz.

Update on COVID-19

Role of CT in Detection of COVID-19

Documents

Physical Medicine - Effective 1/1/21

RadMD Documents

RadMD Documents for Physical Medicine

Recorded General Trainings

Recorded RadMD Demos

Click the link below to see information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.

2013 Jimmo vs Sebelius

Clinical Guidelines

Clinical Guidelines
Refer to the Utilization Review Matrix document to view specific codes managed by NIA

Clinical Training Modules

We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.