Sunshine Health
Also covers / subsidiaries: Sunshine State Health Plan, Centene FL, Sunshine
Core Payer & Clearinghouse Profile
Electronic Payer ID
68069
Centene/Sunshine payer ID; also used by Children's Medical Services Health Plan which Sunshine administers.
Timely Filing Limit (TFL)
180 calendar days from date of service (up to 365 for newborns/retroactive eligibility)
Appeal Window
90 calendar days from payment/denial notification for reconsideration/adjustment/dispute
Clearinghouse Gateway
Availity / Centene EDI (payer ID 68069)
Provider Services
844-477-8313
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Sunshine Health, PO Box 3070, Farmington, MO 63640-3823
Provider Portal
https://www.sunshinehealth.com/providers.html
Largest FL Medicaid (SMMC) plan. The Farmington, MO box above is for adjustments/disputes; verify the first-pass claims box separately. EDI dept: 800-225-2573 ext. 25525.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Sunshine Health.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Sunshine Health.
| 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 Sunshine Health 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 Sunshine Health Denials & Delayed Payments?
Aethera's billing specialists work Sunshine Health every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.