Health Plans

Ambetter from Sunshine Health

Welcome to the Ambetter from Sunshine Health Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.

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

Advanced Imaging Program

Physical Medicine Program

Conservative Treatment Forms

For access to our conservative treatment forms, click here.

RadMD Documents

RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.

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Recorded General Trainings

We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.

Recorded RadMD Demos

Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.

2013 Jimmo vs Sebelius Settlement Agreement

Click here for information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.

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.

Update on COVID-19

Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).