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
Documents
- Frequently Asked Questions
- Quick Reference Guide For Imaging Facilities
- Quick Reference Guide For Ordering Physicians
- Utilization Review Matrix-2021
- Peer-to-Peer Process
Physical Medicine - Effective 1/1/21
- Physical Medicine Provider Education
- Physical Medicine QRG
- Physical Medicine FAQ
- Physical Medicine Tip Sheet
- Ambetter from Sunshine Health Recording of Provider Physical Medicine Training
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
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.
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
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.