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.

Manuals

• Sunflower Provider Office Manual (PDF) - Updated May 8, 2019
• Envolve Dental Provider Manual (PDF)
• Envolve Vision Provider Manual (PDF)
• Envolve Pharmacy Solutions Provider Manual (PDF)
• NIA Imaging Provider Handbook (Imaging)
• LogistiCare (PDF) - transportation

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)
• In-Home Assessments
• Quality Care Pointers for Providers (PDF) (PDF reference resource)
• 837 EDI Companion Guide - Now included in the Provider Office Manual.
• 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.
  • Office Visit Checklist (English) (PDF)
  • Office Visit Checklist (Spanish) (PDF)
• PCP Change Form
  • PCP Change Form English (PDF)
  • PCP Change Form Spanish (PDF)
• Integrated Life Plan (PDF)
• Discharge Consultation Documentation (PDF) - Behavioral health
• Provider Reconsideration and Appeal Form (PDF)
• Authorized Representative Designation Form (PDF)
• Care Grant Request Form (PDF) - used to request care grants for foster care members.

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)

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.