Manuals, Forms and Resources
Ambetter from Sunflower Health Plan
Health Insurance Marketplace
Please see the Ambetter from Sunflower Health Plan website.
Allwell from Sunflower Health Plan
Medicare Advantage Prescription Drug Plan
Provider resources, forms and manuals can be found here.
KanCare - Medicaid
Join us for our Project ECHO series!
Project ECHO is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide best-practice specialty care and reduce health disparities. ECHO trains primary care clinicians to provide specialty care services. This means more people can get the care they need.
Read more and plan to attend an upcoming Sunflower Project ECHO!
Manuals
- Sunflower Provider Office Manual (PDF) - Updated October 26, 2020
- Envolve Dental Provider Manual (PDF)
- Envolve Vision Provider Manual (PDF)
- Envolve Pharmacy Solutions Provider Manual (PDF)
- NIA Provider Handbook
- ModivCare/LogistiCare (PDF) - transportation
Our vendor affiliates manage vision, dental, pharmacy, transportation, OT/PT/ST and radiology benefits.
Payment Policies
Sunflower Payment Policy Manuals
Guides
- Provider Quick Reference Guide (QRG) (PDF)
- Corrected Claims Quick Reference Guide (QRG)
- Sunflower Member ID Card Reference Sheet (PDF)
- HEDIS Quick Reference Guide (PDF)
- HEDIS FAQs (PDF)
- Coordination of Benefits Entry Walk-Through Guide (PDF)
- Person Centered Support Plan Guide (PDF) - Information about how to access the PCSP in our provider portal and submit the waiver provider signature.
- In-Home Assessments
- Quality Care Pointers for Providers (PDF) (PDF reference resource)
- 837 EDI Companion Guide - Now included in the Provider Office Manual.
- CARC/RARC Crosswalk - Claims EX (Explanation) codes from the remittance advice to the CARC (Claims Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) on the Healthcare Claim Payment/Advice (835)
- Appointment Availability and Wait Times
- Preventive and Clinical Practice Guidelines
- DRG Reviews Presentation - from October 2, 2018, webinar
- Consumer Access Guide to HCBS Services in Kansas – From KDADS Community Services and Programs Commission
- New Century Health - For members 21 years of age or older, authorizations for oncology agents listed on the KDHE Prior Authorization Criteria for Oncology Agents and Auxiliary Treatment Agents require review by New Century Health.
- KDHE Smoking Cessation (PDF) - HUD housing is now smoke-free. Tips to help members quit tobacco.
OneCare Kansas
OneCare Kansas is a Medicaid option for some members to receive coordination of physical and behavioral health care with long term services and supports.
OneCare Kansas expands upon medical home models to include links to community and social supports. OneCare Kansas focuses on the whole person and all of his or her needs to manage his or her conditions and be as healthy as possible. All the caregivers involved in a OneCare Kansas member’s health communicate with one another so that all of a patient's needs are addressed in a comprehensive manner.
OneCare Kansas is intended for people with certain chronic conditions, like diabetes, asthma, or mental illness. These people must be KanCare members. They can be members who also receive Medicare along with Medicaid.
Visit the KanCare OneCare Kansas page to learn more.
Forms
- Abortion Necessity
- Consent for Sterilization (PDF)
- Lock-In Beneficiary Referral (PDF)
- Notification of Pregnancy (PDF) (System form available through provider portal)
- Office Visit Checklist - Give this to your patients before their appointments to help create a more thorough conversation and encourage patients to plan ahead and focus on any health changes or issues.
- PCP Change Form
- Member Dismissal Form (PDF)
- Integrated Life Plan (PDF)
- Birth Event Notification (PDF) - Optional form to report birth events/outcomes.
- Discharge Consultation Documentation (PDF) - Behavioral health
- Provider Reconsideration and Appeal Form (PDF)
- Provider Request for External Independent Third Party Review Form (PDF)
- Authorized Representative Designation Form (PDF)
- Care Grant Request Form (PDF) - used to request care grants for foster care members.
- Unsolicited Overpayments, Refunds Worksheet (XLS) - Providers have the responsibility to report “unsolicited” overpayments or improper payments to Sunflower Health Plan. (See the related bulletin.)
Authorization Forms
- Inpatient Prior Authorization Form (PDF)
- Outpatient Prior Authorization Form (PDF)
- Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
- Inpatient Neuropsychological Testing Authorization Request Form (PDF)
- Outpatient Psychological Testing Authorization Request Form (PDF)
- Outpatient Treatment Request Form (PDF) - Behavioral health
- SUD Services Request Form (PDF)
- Psychiatric Residential Treatment Facilities (PRTF) Prior Authorization Request (PDF)
- Autism Authorization Request Form (PDF)
- Prior Authorization for Supported Housing Operation Community Integration (OCI) Program (PDF)
Pharmacy Forms
- Envolve Pharmacy Solutions MAC Pricing Inquiry Form
- Synagis PA Form (PDF)
- Other pharmacy forms - including medication and biopharmacy medication request forms
Resources
Interpreter Services - Providers may call Sunflower directly or direct members to contact Sunflower to arrange for interpreter services.