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, Lori Fink.
Update on COVID-19
Documents
- Announcement Letter
- Frequently Asked Questions
- Quick Reference Guide For Imaging Facilities
- Quick Reference Guide For Ordering Physicians
- Utilization Review Matrix-2021
- RadMD Flyer
- Ambetter From Sunshine Health County Expansion Letter - Effective 1/1/21
- Ambetter from Sunshine Health Webinar schedule
Physical Medicine - Effective 1/1/21
- Physical Medicine Provider Education
- Physical Medicine QRG
- Physical Medicine FAQ
- Physical Medicine Webinar Schedule
- Physical Medicine Tip Sheet
- Ambetter from Sunshine Health Physical Medicine Announcement Letter
- Ambetter from Sunshine Health Recording of Provider Physical Medicine Training
RadMD Documents
- Ordering Provider Access
- RadMD Quick Start Guide
- RadMD Benefits and Logon
- RadMD Upload Feature
- Submitting Clinical Information on RadMD
- RadMD View Exam with Tracking Number
- RadMD Shared Access Quick Start Guide
- RadMD Flyer
RadMD Documents for Physical Medicine
- RadMD Provider Access to Physical Medicine
- RadMD Physical Medicine Quick Start Guide
- RadMD Physical Medicine Upload Feature
- RadMD Request Additional Physical Medicine Visits
- RadMD View Exam with Tracking Number
- RadMD Upload without Login
- RadMD Flyer
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.
Clinical Guidelines
- Clinical Guidelines
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Refer to the Utilization Review Matrix document to view specific codes managed by NIA