Little Havana Activities & Nutrition Centers of Dade County, Inc. ("LHANC") is a TPA-licensed vendor for Sunshine Health in Miami Dade, Broward and Palm Beach County.
Members
ALREADY A SUNSHINE HEALTH MEMBER OR INTERESTED IN ENROLLING?
Providers
Join Our Network
About LHANC and Sunshine Health
Since 2013, Little Havana Activities & Nutrition Centers of Dade County, Inc. ("LHANC") has worked with Sunshine Health as a TPA-licensed vendor. LHANC manages a robust network of Long-Term Care providers in Miami-Dade, Broward and Palm Beach County.
LTC Network Participation Request Form
Please complete all sections and submit below to request participation in LHANC's Long-Term Care provider network.
"*" indicates required fields
PLEASE NOTE: This is not a guarantee of Contract. The information you provide is used by Little Havana Activities & Nutrition Centers of Dade County, Inc. ("LHANC") to evaluate the offering of a Contract and is not representative of an application or a Legal Agreement. Requests are processed in the order they are received. Please allow up to fourteen (14) days for our Contracting team to review your request. A member of our team will contact you to relay if a decision is made to move forward with the contracting process within your region.
If you have not heard back within 14 days, please contact providerrelations@lhanc.org and include the provider name and TIN. You do not need to submit a new request.
Provider Forms
LTC Credentialing Packet (pdf)
Disclosure of Ownership Form (pdf)
W-9 Form (Rev. March 2024) (pdf)
Authorization to Effect Electronic Funds Transfers (EFT) Form (pdf)
ALF Event Log Template (pdf)
Change of Ownership
Step 1:
Required Notice to AHCA
Under Florida Statute §409.907 (Medicaid provider agreements):
The current owner (transferor) must notify AHCA at least 60 days before the anticipated date of the change of ownership.
The new owner (transferee) must submit a Medicaid Provider Enrollment Application to AHCA.
Step 2:
Licensing Requirement with AHCA
For licensed long-term care services, the buyer must apply for a new license or registration due to CHOW, and the application must be received at least 60 days before the proposed effective date.
The submission must include a letter signed by the seller notifying AHCA of the pending sale or transfer.
Step 3:
Contact your assigned LHANC Credentialing Specialist immediately to inform of an upcoming Change of Ownership (CHOW).
If you do not know your LHANC Credentialing Specialist, click below to message LHANC's Credentialing Department.
Step 4:
Navigate to Sunshine Health's website to complete and submit a Change of Ownership (CHOW) notification.
Step 5:
Billing & Claims
How to Register
- Email your Provider Name, TAX ID and contact information to claims@Lhanc.org.
- Allow up to 48 hours to receive notification of successful registration.
- Only one email address can register per agency.
Claims Submission
Submit claims
Check claims status & history
Download Estimation of Payments (EOPs)
Billing Portal Training
Click link below to download our Billing Portal Training submission guide
EDI Providers
- Providers rendering home-based services such as Home Health Agencies, Nurse Registries, Homemaker & Companion, and Participant Direct Option (PDO) providers are required to submit all claims via Electronic Visit Verification (EVV).
- Claims submitted by EDI providers directly to LHANC’s Provider Claims Portal shall be subject to a claims rejection.
- LHANC utilizes HHAeXchange as its Electronic Visit Verification (EVV) platform for Long Term Care services.
Grievances & Appeals
A provider may file a Grievance or Appeal verbally or in writing at any time by: one of the following methods:
Click the link below to download our Claims Appeal Form. Complete and submit all requests to: providerrelations@lhanc.org or
via Fax: (888) 331-3574
Send a written request by mail to:
Little Havana Activities & Nutrition Centers of Dade County, Inc.
700 SW 8th Street
Miami, FL 33130
ATTN: Grievance & Appeals
Need Help?
Contact our dedicated Toll Free Provider Hotline at
1 (844) 776-0593
or email us directly at claims@lhanc.org so that one of our representatives can assist.
Please have your Company Name, TAX ID and/or Medicaid ID ready for verification.
LHANC Provider Call Center Policy on AI/Automated Calls
LHANC cannot accept calls from Artificial Intelligence (AI) systems or other automated platforms for tasks such as verifying claim status, obtaining remittance details, or addressing any other types of inquiries. To protect member privacy and maintain HIPAA compliance, LHANC representatives will only interact with live callers.
Pre-Authorization Checklist
Case Management
All Sunshine Long-Term Care members assigned to Little Havana Activities & Nutrition Centers of Dade County, Inc. ("LHANC") are cased managed by Florida Care Management Services Agency, Inc. (“FCMSA”) -- a TPA-licensed vendor for Sunshine Health.
Prior Authorizations
Prior authorization is required for ALL services and products billed to LHANC for Long-Term Care eligible members. Claims billed without a prior authorization will be automatically denied by our claims system. Therefore, providers are advised to request and secure a prior authorization prior to rendering services to avoid claims reimbursement issues.
Authorization Requests
To request a prior authorization, please contact FCMSA:
Toll Free: 1 (877) 462-1200
Direct: (786) 477-4110
Eligibility Verification
Sunshine Health is responsible for providing LTC services once the Florida Department of Elderly Affairs determines an enrollee meets the medical requirements for nursing home level of care and the enrollee formally selects the Sunshine Health Comprehensive plan through AHCA’s Choice Counseling. Following that selection, the Department of Children and Family Services (DCF) determines if the member meets the financial criteria. Once AHCA receives confirmation of a member’s eligibility, AHCA notifies Sunshine Health of the member’s effective enrollment date. Coverage typically lasts for a year until DCF re-certifies the member.
During the annual recertification process, Comprehensive members may receive a 60-day extension of coverage and their benefit category is changed to “SIXT” on the secure provider portal of AHCA’s website.
Methods to Verify Eligibility
- Providers are asked to verify member eligibility by using the Sunshine Health's Secure Provider Portal. Using the portal, any registered provider is able to quickly check member eligibility by indicating the date of service, member name, and date of birth or the Medicaid ID number and date of birth.
- Providers may call Sunshine Health Provider Services at 1 (844) 477-8313. Providers are asked to supply the member’s name and date of birth or the member’s Medicaid ID number and date of birth.
Electronic Visit Verification (EVV)
Both LHANC and Sunshine Health collaborate with HHAeXchange (HHAX) and its electronic visit verification (EVV) technology to enhance member service and comply with the Agency for Health Care Administration's (AHCA) Statewide Medicaid Managed Care contract.
The HHAX portal remains LHANC’s and Sunshine Health’s method for communicating authorization information and billing to providers.
Effective January 30, 2025: LHANC and Sunshine Health will no longer accept EVV claims that have not been electronically confirmed or missing the appropriate visit exception reasons. We encourage providers to reduce and eliminate EVV exceptions — including manually altered visit times — to avoid any reimbursement delays.
To guarantee real-time EVV data collection, all visit files from providers using a third-party Electronic Data Interchange (EDI) vendor must be sent to HHAeXchange at least every two weeks.
Florida Providers NPI Data Changes
Florida has changed how it accepts electronic claims/encounters: Billing provider information must exactly match the National Provider Identifier (NPI) that AHCA has on file or the encounters will be denied. Providers must ensure they are validating their agency’s data and address on the Provider Master List (PML). Any changes made to the PML must be communicated to LHANC so health can update agency records.
Sunshine Health put together a tip sheet to help providers navigate these changes:
Step 1: Complete Your Trainings
All LHANC Participating Long-Term Care Providers are required to complete the trainings listed below upon initial credentialing and on an annual basis.
Fraud, Waste & Abuse Training (pdf)
Anti-Kickback-Training (pdf)
Model of Care Training (pdf)
Step 2: Submit Your Training Attestations
Signed attestations must be submitted to LHANC’s Credentialing Department at credlh@lhanc.rg or faxed to 1 (888) 331-3574.
FWA Training Attestation Page (pdf)
Anti-Kickback Training Attestation (pdf)
Model of Care Training Attestation Page (pdf)
Please contact lhancproviderrelations@lhanc.org if you cannot find an answer to your question.
Visit our Join Our Network page and submit a Network Participation Request Form.
PLEASE NOTE: This is not a guarantee of Contract. The information you provide is used by Little Havana Activities & Nutrition Centers of Dade County, Inc. ("LHANC") to evaluate the offering of a Contract and is not representative of an application or a Legal Agreement. Requests are processed in the order they are received. Please allow up to fourteen (14) days for our Contracting team to review your request. A member of our team will contact you to relay if a decision is made to move forward with the contracting process within your region.
If you have not heard back within 14 days, please contact providerrelations@lhanc.org and include the provider name and TIN. You do not need to submit a new request.
Contact Us
For any questions regarding contracting or credentialing, please contact your assigned Credentialing Specialist.
LITTLE HAVANA ACTIVITIES & NUTRITION CENTERS
Hours
Mon - Fri: 9:00 AM - 5:00 PM
Sat & Sun: Closed