Sunshine Health CMS to Molina Healthcare Transition
On October 1, 2026, your CMS insurance switches from Sunshine Health to Molina Healthcare. Office Puzzle automates most of the transition, but you have 3 responsibilities by September 30.
Key Dates
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09/16-09/30: Molina CMS plan is ready
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09/30: Deadline for all Sunshine appointments
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10/1: Migration goes live
What Is Changing
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Insurance Provider Switchover: Your clients move from Sunshine Health to Molina Healthcare. Member IDs and rates stay the same.
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Prior Authorization (PA) Transfer: Remaining units from Sunshine automatically move to Molina. If a client had 10 units, they get 10 under Molina.
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Continuity of Care (COC) Protection: Molina honors all PAs for a minimum of 90 days. Rates are protected for 60 days.
What Office Puzzle Handles (Automated)
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Between 9/16 - 09/30: Clone your Molina CMS plan with the same rates as Sunshine.
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On 10/1: All clients move to Molina. Sunshine ends 09/30, Molina begins 10/1.
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On 10/1: All PAs migrate to Molina with remaining units calculated as of 9/30 EOD.
What You Must Do
Activity 1: Clone the Plan (We suggest doing it today) - Less than 2 minutes
Step 1: Open the notification email from Office Puzzle
Step 2: Click the link to the migration module
Step 3: Review and confirm the Sunshine plan to clone
Step 4: Confirm the Molina plan creation
Activity 2: Clean Up Appointments (By 9/30) - Critical for accuracy
Log all appointments completed before 10/1 by end-of-day 9/30. Verify no appointments are scheduled after 9/30 under Sunshine CMS. This ensures remaining units are calculated correctly.
Activity 3: Initiate Migration (10/1) - 5-7 minutes
Step 1: Log into Office Puzzle on October 1
Step 2: Open the migration module
Step 3: Confirm the client migration
Step 4: Verify all clients show Molina CMS as active
Important
PA Unit Calculation: Once you move to Molina on 10/1, remaining units are locked in based on what was completed by 9/30 EOD. Any appointments logged after 9/30 will not be deducted from the new Molina PA units.
After Migration: What to Monitor
+60 days (Nov 30): Rate protection ends. Confirm or renegotiate direct contract with Molina before rates change.
Throughout COC (through Dec 31): Monitor PA expiration dates. Molina has not confirmed if it will auto-extend PAs. If a PA expires, contact support immediately.
+90 days (Dec 31): COC period ends. Finalize all contracting and credentialing with Molina for long-term service delivery.
Troubleshooting
A client has a new member ID or the PA did not transfer
Contact our support team with the client name and member ID. This may require escalation to Molina.
A PA expires before the end of COC and the client needs care
Do not provide services without a valid PA. Contact support immediately so we can work with Molina to extend or reissue the authorization.
I logged appointments after 9/30 and they show under Molina
The Molina PA units will not be adjusted for appointments logged after 9/30 EOD. Contact support if you need to correct the calculation.
Questions? Contact support@officepuzzle.com or use live chat.