Get Sunshine Health Providers Form

Filling out the Sunshine Health Providers Form online is a straightforward process designed to assist providers in updating their information efficiently. This guide provides detailed, step-by-step instructions to help users complete the form with ease and accuracy.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Contact Person' field. Enter the name of the individual who can be reached for questions regarding this form.
3. Next, provide the 'Contact Phone Number'. Ensure the phone number is accurate to facilitate any necessary communication.
4. Fill in the 'Group Name' if you are part of a healthcare group. If not applicable, you may leave this section blank.
5. Input your 'Group Tax ID'. This is a unique identifier for your tax purposes and is essential for accurate record-keeping.
6. Enter your 'Group NPI', which is the National Provider Identifier for your group. If you are an individual provider, omit this step.
7. Fill out your 'Group Medicaid' information if applicable, as this is critical for Medicaid billing.
8. If you are an individual provider, please provide your 'Individual Provider Name' and 'Individual Provider NPI'. These identifiers will help in processing your information.
9. Select the 'Type of Update' from the options provided, detailing what information you wish to update.
10. If applicable, check the 'Physical Address Update' box and fill in the new address details.
11. Similarly, if there is a change in the billing address, check the 'Billing Address Update' box and provide the new address.
12. For 'Non Contracted Provider Load', specify 'YES' or 'NO' based on your status.
13. Indicate if you wish to 'Remove from Group' by selecting 'YES' or 'NO'.
14. If you would like to 'Add to Existing Group', please check 'YES' or 'NO'.
15. For updating the 1099 address, select ‘YES’ or ‘NO’. Include any additional comments in the 'Comments' section as needed.
16. Review all entered information for accuracy before proceeding. Ensure all necessary fields are complete.
17. Once finished, users can save changes, download, print, or share the form as needed.
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