Children's Medical Services Health Plan
Also covers / subsidiaries: CMS Health Plan, CMS Managed Care Plan
Core Payer & Clearinghouse Profile
Electronic Payer ID
68069
Administered by Sunshine Health (Centene), so it bills under Sunshine Health's payer ID 68069 and rules.
Timely Filing Limit (TFL)
180 days from date of service (Sunshine Health rules)
Appeal Window
Claim reconsideration/adjustment 90 days from notification of payment or denial
Clearinghouse Gateway
Availity / Centene EDI (payer ID 68069)
Provider Services
Varies — confirm via portal / clearinghouse
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Sunshine Health, Attn: Adjustments/Reconsiderations/Disputes, PO Box 3070, Farmington, MO 63640-3823
Provider Portal
https://www.sunshinehealth.com/members/cms.html
Specialty plan for children with special health care needs; administered by Sunshine Health. As of 7/1/2025 CMS enrollment transferred to AHCA — confirm current administration.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Children's Medical Services Health Plan.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Children's Medical Services Health Plan.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Absolute Total Care | 68069 | Non-Par | None | |
| Advantage By Bridgeway Health Solutions | 68069 | Non-Par | None | 837P837I835 ERA |
| Advantage By Buckeye Community Health Plan | 68069 | Non-Par | None | 837P837I835 ERA |
| Advantage By Managed Health Services | 68069 | Non-Par | None | 837P837I835 ERA |
| Advantage By Superior Healthplan | 68069 | Non-Par | None | 837P837I835 ERA |
| Advantage Health Solutions | 68069 | Par | None | 837P837I270/271Dental |
Resolution Tools for Children's Medical Services Health Plan Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing Children's Medical Services Health Plan Denials & Delayed Payments?
Aethera's billing specialists work Children's Medical Services Health Plan every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.