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Claims Quick Reference Guide

Navigating Sunflower Health Plan Claims and Payment

The Sunflower Health Plan Claims Resolution Process can help guide you through some common claims and payment-related issues. Within this page, you’ll find the steps you’ll need to take if:

  • Your claim was denied 
  • You are awaiting payment for a submitted claim
  • You have a question about how your claim processed 
  • You've noticed a concerning trend in your claim denials/payments
  • You want a progress update on an existing claim issue

Claim Resolution Process

*Three additional calendar days will be allowed for mailing time. For additional information, please see Provider Manual, EOP or resolution decision letter.
 Reconsideration (Optional Step)AppealExternal Independent Third-Party Review (EITPR)State Fair Hearing
Deadline to SubmitWithin 120* calendar days from the date of the EOP.Within 60* calendar days from date of the EOP.Within 60* calendar days from the date of the notice of appeal resolution.Within 120* calendar days from the date of the notice of appeal resolution.
How to Submit

Call Customer Service: 1-877-644-4623

Mail: Address listed in EOP

Provider Portal: Claim detail submit Claim Reconsideration

Completed Claim Appeal form

Mail: Address listed in EOP

Provider Portal: Claim detail submit Claim Appeal

Completed EITPR Request Form

Mail: Sunflower Health Plan Appeals Dept., 8325 Lenexa Dr., Ste. 410, Lenexa, KS 66214

Fax: 1-888-453-4755

Phone: 1-785-296-2433

Mail: Office of Administrative Hearings (OAH) 1020 Kansas Ave., Topeka, KS 66612

Resolution Details

Notification Type: Revised or unrevised EOP (for same claim number).

Timeline: Will be resolved within 30 calendar days of receipt.

Notification Type: Written Provider Appeal Resolution Notice

Within 10 calendar days, provider will receive a written acknowledgment of their appeal request.

Within 30 calendar days from date of receipt, a resolution decision

Notification Type: Written resolution notice from Sunflower Health Plan.

Notification Type: Written communication from OAH

Timeline: Varies at discretion of OAH

Claims and Payment Information

For more information, please see our Provider Manual, specifically the Appendices which contains helpful information around claims. 

Claims Trend Identification

Have you noticed an underlying or ongoing issue that is affecting 10 or more of your practice's Sunflower Health Plan claims?

Instead of digging through your records to identify all potentially affected claims, you can alert us to the issue by providing one example claim and a brief description of the trend you are seeing. Email the information to your Provider Relations Representative or to providerrelations@sunflowerhealthplan.com.