Credentialing with Florida Medicaid plans: Sunshine Health, Simply and Molina Healthcare

Where do you apply for Molina Healthcare credentialing and the other Region I plans?

AHCA’s Sept 30, 2026 report shows eight SMMC plans with Managed Medical Assistance (MMA) members in Region I (Miami-Dade and Monroe), each with its own route in:

Sources: AHCA, Florida Medicaid Monthly Enrollment Report, September 2026 (MMAC sheet; Florida Community Care’s 221 ICMC members not shown; AmeriHealth Caritas Florida lists 0); each plan’s join page and manual.

Most want your Medicaid ID first: Molina contracts only with “an enrolled Medicaid provider” holding “a valid and active Medicaid ID,” Humana and Simply (for PCPs) want you enrolled before contracting, Florida Community Care requires full enrollment, and Sunshine rejects a Provider Master List status of “Registered.” Getting the ID is covered on our Florida Medicaid enrollment page; the other routes of three of these insurers are in our UnitedHealthcare, Aetna and Humana guides.

Which Florida rules apply to Molina Healthcare credentialing and every other plan?

The 60-day onboarding clock: to check it, AHCA has each plan report the date it received your full and complete application on its Provider Network Verification file. A plan that misses it may face sanctions or liquidated damages, and AHCA’s program snapshot lists $5,000 per occurrence for credentialing failures. A plan may also sign you while your Medicaid enrollment is pending, for up to 60 days.

What every plan still verifies for physicians, beyond what your state enrollment proves (MMA contract, Exhibit II-A):

• good standing at your primary admitting hospital, or a coverage arrangement with a physician who has privileges there;
• a valid DEA certificate, where applicable;
• an attestation that your total active patient load, all payers, is no more than 3,000 per primary care physician, counting patients seen at least twice a year;
• for each PCP, a site visit survey in good standing: facilities, disability access, space, sanitation, smoke-free rooms, fire safety and record keeping;
• a CV or application with at least 5 years of work history, and proof of training, for which board certification suffices.

Recredentialing comes at least every 3 years, and all eight plans’ manuals publish a three-year or 36-month cycle (recredentialing). The statute lets plans limit their networks:

“Except as provided in this section, managed care plans may limit the providers in their networks based on credentials, quality indicators, and price.”

A plan that declines you must give you written notice of the reason (SMMC contract, Attachment II §VII.B.1.b; 42 CFR 438.12(a)(1)).

What do the Molina credentialing application and forms ask for?

Molina’s route, in its order:

1. Contract Request on Molina’s Provider Network Management portal, with an active Medicaid ID.
2. Documents in the portal: a W-9, credentialing information, your Medicaid ID numbers, the PCP form below and Molina’s roster file (its template appears once you have a login).
3. CAQH: complete, Molina authorized to view it, attested in the last 120 days, no expired documents.
4. Credentialing: practitioners Molina contracts with “must be credentialed prior to the contract being implemented.”
5. Contract: Molina countersigns your Provider Agreement and loads you as in-network.

Primary care practitioners sign the FL PCP Patient Capacity Attestation, Molina’s Attestation and Release of Information Form. It asks whether you have more than 3,000 patients “seen a minimum of (3) times per year” (the state contract counts two visits) and whether you’re eligible to become a Medicaid provider, takes your CAQH number, and rejects a stamped signature or any change to its wording.

Unlike Simply, Molina doesn’t require board certification once you’ve completed an accredited residency.

How does Simply Healthcare provider credentialing work?

Simply, an Elevance plan and Region I’s largest, sets criteria above the state’s:

• Board certification: MDs and DOs need current, in-force certification, or must earn it within five years after residency or fellowship (or the board’s eligibility window, if longer).
• Hospital privileges: unrestricted privileges at an accredited hospital; outpatient-only practices are judged without regard to privileges, with a referral arrangement for inpatient care.
• DEA: a pending registration is accepted with an alternate prescriber arranged, but the DEA must arrive within 90 calendar days or the practitioner is terminated from the network.
• The file: five years of work history in month/year format, current liability insurance, and a site review within 30 days of Simply’s request, if applicable.

How do Sunshine Health home health and behavioral health providers join?

Through Sunshine’s Network Participation Request Form: choose your service type (Behavioral Health, or Long Term Care-Type Specialties for home health agencies, assisted living facilities and nursing homes) and attach a Disclosure of Ownership Form, a Contract Request Form, a W-9 signed within the last 12 months, the LOAP practitioner roster and a current malpractice certificate. No answer in 14 days? Email SunshineContracting@SunshineHealth.com with the provider name and TIN; for niche behavioral specialties, Sunshine’s page promises a review within one business week.

• Provider Master List: each practitioner must show “Limited Enrollment” or “Enrolled,” active, with a taxonomy that matches the specialty requested; mismatches come back unprocessed.
• CAQH: access granted to Centene Corporation and attested within the last 120 days.
• Site review: 80% or better for PCPs, pediatricians, OB/GYNs, high-volume behavioral health providers and non-accredited facilities.
• Patient load: Sunshine’s 2026 form caps each PCP at 750 MMA patients, citing AHCA (the contract: 3,000 of all payers), so read each plan’s form before signing.
• Home health billing: since Jan 30, 2025, Sunshine rejects EVV claims that aren’t electronically confirmed or lack visit exception reasons.

Where do Simply Healthcare mental health providers and other behavioral clinicians apply?

• Simply: Carelon Behavioral Health, Simply’s Elevance affiliate; providers who want to join call 1-800-397-1630.
• Humana: Carelon Behavioral Health in Regions B–I, through Humana’s Behavioral Health Provider Inquiry Form; Humana contracts behavior analysis providers itself.
• UnitedHealthcare: Optum, through providerexpress.com.
• Aetna Better Health and Florida Community Care: the same statewide behavioral network vendor, 1-305-907-7470 (Aetna’s manual lists 833-907-7470).
• Molina, Sunshine and Community Care Plan: in-house; for its MMA plan, “Molina manages all components of covered services for behavioral health.”

License by license: mental health credentialing; for behavior analysts, ABA credentialing.

When does in-network start after a Molina Healthcare provider credentialing application?

What you can do today

1. Check each provider’s Provider Master List record: Limited Enrollment or Enrolled, active, with the taxonomy of the specialty you’ll request.
2. In CAQH (DataSpring), authorize each plan (Molina; Centene for Sunshine) and re-attest if the last attestation is near 120 days old.
3. Molina: submit the Contract Request on its portal, and have PCPs sign the Patient Capacity Attestation.
4. Sunshine: file the Network Participation Request Form with a fresh W-9, and calendar day 14 for the follow-up email.
5. Calendar day 60 from each full and complete application, and ask the plan for status if nothing has arrived.
6. Keep plan members off a new provider’s schedule until the plan confirms the effective date.

Our payer enrollment service covers the preparation, submission, monitoring and follow-up of credentialing and enrollment applications.