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Elective Inpatient Surgical Procedures Implementation

Date: 01/22/25

Effective, March 1, 2025, Sunflower will be adhering to the Elective Inpatient Surgical Procedure prior authorization guidelines. 

Sunflower is committed to working with providers to ensure members are at the appropriate level of care.  An elective admission is an admission in which the decision to admit can be separated in time from the actual admission and is scheduled in advance of the admission date. 

Elective inpatient admissions require prior authorization. The provider must notify the plan within five days prior to the requested service date. Once admission occurs, the facility must notify Sunflower of the admission within one business day in order for concurrent review and discharge planning activities to occur. 

Use the Sunflower Prior Authorization Pre-Screening Tool online or contact a representative.

Medicaid Pre Auth Check Tool Example:

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the numbers below.