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 January 21,2020
- Envolve Dental Provider Manual (PDF)
- Envolve Vision Provider Manual (PDF)
- Envolve Pharmacy Solutions Provider Manual (PDF)
- NIA Provider Handbook
- LogistiCare (PDF) - transportation
Payment Policies
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)
- 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)
- EPSDT Provider Reference Kit (update in progress)
- 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
- KDHE Smoking Cessation (PDF) - HUD housing is now smoke-free. Tips to help members quit tobacco.
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
- Integrated Life Plan (PDF)
- 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.