Skip to Main Content

External Independent Third-Party Review (EITPR)

After Sunflower’s appeal process is complete, your treating provider may ask for an external review of Sunflower’s decision. You cannot request this review yourself.

To request an external review, your provider should fill out the EITPR request form that comes with the appeal decision letter.

How EITPR Works:

  • Request for Review: Your provider can only ask for this review if Sunflower denied new healthcare services. This does not apply to cases where Sunflower reduced, suspended or ended services that were previously approved.
  • Time Limit: The provider must request the review within 60 calendar days from the date on the Notice of Member Appeal Resolution. Three extra days are allowed for mailing.
  • Review Process: Sunflower will send the request to the Kansas Department of Health and Environment (KDHE), which will assign the review to an outside agency for review.
  • Review Results: Once the review is done, Sunflower will send you and your provider a letter with the review decision.
    • If the external reviewer agrees with Sunflower’s decision, the provider who asked for the review will pay for the review. If the reviewer disagrees with Sunflower’s decision, then Sunflower will pay for the review. No one is allowed to ask you to pay for the external review.
    • If the reviewer agrees with Sunflower’s decision, you can ask for a State Fair Hearing. If an EITPR was done, you must request a State Fair Hearing within 30 calendar days from the date on Sunflower’s Notice of EITPR Resolution. Three extra days are allowed for mailing.

Please work with your treating provider to decide if they will ask for an EITPR. If they do request an EITPR, it’s usually best to wait until it’s fnished before asking for a State Fair Hearing, but this isn’t mandatory.