Sunshine Health-WellCare Integration Means You’ll Have One Representative Focused on Your Needs
Dear Valued Provider Partner,
We are excited to announce the integration of Sunshine Health and WellCare’s Provider Relations teams.
This means you will have one Provider Relations Representative to assist you in serving both Sunshine Health and WellCare of Florida members, including our Medicaid, Medicare and Ambetter members and our specialty health plan members in Sunshine Health’s Child Welfare Specialty Plan, Staywell’s Serious Mental Illness (SMI) Specialty Plan and the Florida Department of Health’s Children’s Medical Services Health Plan (CMS). This change will be effective Aug. 3, 2020.
We expect to fully integrate our two companies in the second half of 2021, subject to the Agency for Health Care Administration’s approval. We are taking this step now to provide you with more streamlined and efficient service.
We Need Your Feedback
Our goal is to build a best in class Provider Relations team to meet your needs. Your input and feedback is crucial. In the coming days, you will receive a survey seeking your opinions about what each of our organizations does best, as well as how we can improve.
When we fully integrate, we will unite all of our products under the Sunshine Health brand. We are committed to keeping you up to date on changes before we make them. We created a new Better Together webpage where you can find all the integration information in one place.
Follow Your Current Contract(s)
For now please continue to treat members from each health plan as you do under your current contract. Our operational systems for each health plan, including Claims and Provider Services, remain separate. If you have questions, your Provider Relations representative is available to help you, regardless of whether your question is about Sunshine Health or WellCare, including CMS Health Plan. In some cases, your representative may change. We’ll let you know in advance if that happens. You can also call our dedicated Provider Relations Number at 1-407-551-3200, option 2.
Please see the attached Frequently Asked Questions for more information and remember to bookmark our Better Together web page. In addition, we will be hosting Provider Town Halls throughout Florida (or virtually, if needed) in fall 2020 to discuss our integration. We will send you an invite. Hope to see you there!
William Kruegel, Chief Operating Officer
Duenna Dorsett, Vice President of Provider Engagement
Frequently Asked Questions
How does this help my practice?
Your Provider Relations Representative will be specially trained to understand the nuances and needs of your practice. Having one rep will also streamline communications, helping us align accountability, eliminate duplications and provide a consistent message.
Will my rep change? When will I be told?
In some cases, your Provider Relations Representative may change – but in many cases you will simply keep one of your existing representatives. If you will have a new representative, we will let you know in advance.
How does this help/what changes for my patients?
The entire integration process should be seamless to your patients but they will benefit from the extra care and efficiency you receive through this streamlined process.
Will members have/need new ID cards?
For now, members will continue to use separate ID cards. We will let you know in advance when that changes.
Now that I have one Provider Relations Representative for both WellCare and Sunshine Health, can I also file claims in a single place? Can I verify membership in a single place?
Not yet. Please continue following the same claims, authorization and verification processes you have been using under your current contract(s). We will let you know when we expect those systems to be fully integrated.
Are member benefits also changing?
Member benefits are not changing. Please follow current processes until further notice.
Will my WellCare members be eligible for Sunshine Health Provider Quality Incentives?
For now, incentive programs will remain separate. Please follow the current process until further notice.
What if I communicate with Sunshine Health through a vendor but directly work with WellCare?
If you work with a vendor for Sunshine Health, you will continue to work with that vendor.
Do I now accept both Sunshine and WellCare patients if previously I only accepted one or the other?
No, your contract(s) remain the same.
Why should I attend a Provider Town Hall if I already meet regularly with my Provider Relations Representative?
Integrating the Provider Relations team is one of the first steps toward fully integrating our companies in 2021. We want you to have input and stay informed every step of the way. At the Town Halls, you’ll have an opportunity to meet your Provider Relations Representative, hear from Subject Matter Experts and take part in a Q&A session. We’ll let you know if these will be in person or online.
Does this change to which specialists I can refer my patients?
Our provider networks are not yet combined. Please follow your contract(s) for now.