The Agency previously announced effective October 1, the operation of the Children's Medical Services (CMS) Plan will move from Sunshine State Health Plan, Inc. (Sunshine) to Molina Healthcare of Florida, Inc. (Molina).
To ensure no disruption in current services and to support continuity of care, Molina will allow enrollees to continue receiving their Medicaid-covered authorized prescriptions through their current provider until the prescriptions expire or can be transferred to a provider in the plan's network.
Pharmacies should follow the process outlined below to receive reimbursement for services provided to a CMS Plan enrollee.
Effective October 1, pharmacies should bill Molina's Pharmacy Benefits Manager (PBM) for CMS Plan enrollees. If a pharmacy inadvertently bills Sunshine and receives a denial, the pharmacy should immediately bill Molina's PBM using the information below to process the claim(s). The pharmacy may ask the enrollee to provide their new membership card to obtain the health plan billing information.
Molina: CVS Caremark
- PBM Services Pharmacy Help Desk: 1-855-276-6580
- Group Number: RX51EN, RX51EP
- BIN Number: 004336
- PCN Number: MCAIDADV
For member questions regarding this transition, contact Molina Member Services at 1-800-262-0750. For provider questions regarding this transition, contact Molina Provider Services at 1-855-322-4076.
If enrollees encounter any issues, please refer them to the Medicaid Help Line at 1-877-254-1055 (TDD 1-866-467-4970).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.