Providers & Partners

Providers & Partners

Need a specialist referral?

If you need a specialist referral, you can call our Utilization Management Department at 1-844-896-0628, send a fax to 1-800-504-4752 or call 1-844-502-4149 for Illinois Member Services.

EZ-NET Provider Portal Access

If you are a current Sunrise Advantage Plan provider, log in to use the EZ-NET Provider Portal. Or, click here to submit a batch of claims.

The Sunrise Advantage Plan EZ-NET Provider Portal offers Providers secure, web-based access to healthcare information, including claims, eligibility, benefits, and authorizations. And, its secure method protects the HIPAA privacy of our Members.

The EZ-NET Provider Portal allows Providers access to:

  • Submit authorization requests and claims into the EZ-CAP system
  • Inquire on authorization status
  • Verify Member eligibility
  • View Member authorization history
  • Check the status of claims/encounter information
  • Look up procedure codes, diagnosis codes, and other general reference information

Providers can register a new user through the New User Registration link on the EZ-NET Provider Portal.

After registering as a New User, you will receive a confirmation email message asking you to verify your account. The email will be sent to the email address you provided. To confirm your account, click on the confirmation link provided in the email.

Once the EZ-CAP Administrator verifies your account in EZ-CAP, you will be notified that your EZ-NET login is fully activated, and you will receive directions on how to access the EZ-NET Provider Portal.

For a forgotten username or password, Providers should click on “Forgot Username/Password” on the EZ-NET Provider Portal.

You will be taken to a new screen where you will enter your username and email address to retrieve your password.

Click “Clear” to clear all entries or click “Next” to submit request to reset your password.

Click on the hyperlink “Forgot Your Username” to retrieve your username. (Note—this will only work if the password recovery question and answer setup has been created.)

If you are unable to do password recovery, send a password reset request to eznetsupport@allyalign.com. Make sure you include your username so that we can locate your EZ-NET user account. You can also call Plan Toll Free Number option 4 for assistance on password resets and status of claims submission.

Electronic Claims Submission

Exchange EDI

Claims and remittance advices can be submitted and retrieved electronically through your existing clearinghouse or billing company. The following steps will guide you through the process.

  1. You do not need to enroll for electronic claims submission, however, to receive an 835, one of the following must occur:
    1. Submit a claim electronically. If the NPI is not already flagged for 835, the payer customer support will be notified by EDI that the provider wants to receive 835. This process will take 24 hours for the 835 indicator to be flagged.
    2. The clearinghouse or billing company can notify the EDI technical support desk via email that the provider wants to receive 835s. The technical support desk will notify the payer customer support in advance of receiving the claims. The technical support desk email is helpdesk@claimsnet.com.
  2. If you are using a clearinghouse or billing company, notify them that you wish to submit claims electronically and retrieve remittance advice for the Plan. You can provide the Plan Payer ID but be aware that each clearinghouse or billing company may have their own unique naming convention for payer IDs. If the clearinghouse or billing company has any questions, they can call our technical help desk directly at 888-635-0009, option 2.
  3. If you do not use a clearinghouse or billing company, you can use the EZ-NET Provider Portal for online submission.

For ease of processing payment, electronic claims are preferred; however, if you are unable to send us a claim electronically, please mail it to:

Sunrise Advantage Plan
PO Box 908
Addison, TX 75001-0908

For Prescribers & Pharmacies

Access Formulary and Prior Authorization Forms at www.navitus.com

1. Select “Prescribers” and click on “Prior Authorization”
2. Enter your NPI number and state to access the prescriber portal

Navitus Health Solutions Pharmacy Help Desk
Phone number: 1-866-270-3877
TTY phone number: 711

Access payer sheets and other information at www.navitus.com

1. Select “Pharmacies” and click “Pharmacies Login”
2. Enter your NPI number and NCPDP number to access the pharmacy portal

Navitus Health Solutions Pharmacy Helpdesk
Phone number: 1-866-270-3877
TTY phone number: 711

Institutional Special Needs Plan (ISNP) Model of Care & Training

At Sunrise Advantage Plan, we specialize in improving healthcare and advancing a truly unique philosophy of care to meet the complex needs of the institutional Medicare beneficiary population, while simultaneously streamlining administrative functions for our Providers.

The Sunrise Advantage Plan Model of Care focuses on providing a unique level of customized clinical care and services for residents in nursing facilities. As we help extend your care, our care model concentrates on addressing each Member’s full range of medical, functional, and behavioral healthcare needs in a coordinated and Member-centric manner. This means putting the Member’s preferences at the center of the care planning process and leveraging Provider resources to ensure every Member receives the services necessary to achieve their short- and long-term care goals.

Our model organizes best practices and industry innovations including:

  • The Advanced Nurse Practitioner (ANP) and primary care physician (PCP)/NFist (a PCP specializing in the care of nursing home patients) care team providing onsite, facility-based PCP support
  • A risk assessment tool designed for a senior, nursing facility patient population
  • A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP)
  • A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for care coordination
  • Frequent face-to-face Member and caregiver/family member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.

It is important that all of our Providers are properly trained and informed about the Sunrise Advantage Plan Model of Care. Our top priority is making sure all of the providers in the Sunrise Advantage Plan network meet the training and education needs of our institutional Medicare beneficiary population.

The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care. In addition, this will also help you to seamlessly serve Sunrise Advantage Plan Members, your patients.

Become a Network Provider

Sunrise Advantage Plan contracts with physicians, facilities, and other allied providers to ensure we have an adequate provider network which is essential for the delivery of healthcare services to our members. All providers must be credentialed before they can be added to our network as a participating provider.

Why Partner with Sunrise Advantage Plan?

From the beginning, physicians discover that Sunrise Advantage Plan isn’t just another Medicare Advantage health plan. We have a different philosophy, attitude, and approach to caring for our Members. Our emphasis is on encouraging proactive healthcare and offering programs and services that can make a difference in our Members/your patients’ quality of life. We believe in providing our Members exceptional benefits and an abundance of attention. And we believe Sunrise Advantage Plan Providers deserve the same.

For more information on becoming a Sunrise Advantage Plan contracted Provider, please contact Network Operations at 1-844-896-0628 (TTY: 711) (NY, VA, PA), 1-844-502-4149 (IL) or via email here.

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