Sunflower Medicaid Provider Manual Revised

Date: 03/31/25

Revision Now Available

The Sunflower KanCare provider manual has been updated and is now available on the Provider Resources page of our website.

The manual changes include the following:

Provider Manual Section	What Was Updated?	Page Number
Key Contacts and Important Phone Numbers	Pharmacy Service fax numbers Centene Dental Services Centene Vision Services New Century Health now Evolent SafeRide Language Line	Page 3
Sunflower Website	Availity Essentials	Page 5
Kansas Medicaid Program	Eligible populations	Page 5
Contracting and Network Development	Provider Right to Be Informed of Applicaton Status	Page 7
Beneficiary and Attorney Requests and Subpoenas	Addition of 45 C.F.R. Sec 164.52(b)(2) Additon of KMAP Provider Manual website link	Page 15
Appointment Availability and Wait Times	2025 Standards updated	Page 20-21
Member Interpreter Services	Advance notice is not required	Page 26
Advance Directives	Kansas law related to conscientious objection.	Page 26-27
Benefit Explanation and Limitations	Dental Services Dentures or Partials Doula Services Home Births Vision and Eye Exams Early and Periodic Screening, Diagnosis and Treatment	Page 28-34
Value-Added Services for Members	2025 Value-Added Services	Page 37-40
Inpatient Authorizations	All inpatient elective procedures	Page 43
Authorization Determination Timelines	Changed from 14 calendar days to 7 calendar days	Page 46
Utilization Review Criteria	Medical Necessity Criteria followed by the health plan	Page 49
Medical Records Management and Records Retention	NCQA Standards and 42 CFR §456	Page 54
Paper Claims Submission	SafeRide	Page 62
Grievance and Appeal Process	Record retention update to 10 years Potential timeframe extension for a member grievance  Member Appeals needing more than 30 days to resolve Timely filing denial with extenuating circumstances Timeline standards Centene Vision Services Centene Dental Services	Page 71-79
Quality Assessment and Performance Improvement Program Scope and Goals	QAPI Program Quality Improvement Committee	Page 80-81
DME/Supplies/Prosthetics and Orthotics	Invoice and MSRP are required.	Page 119
Appendix XIII	Participating Provider Agreement Sample	Page 135-145

Thank you for your partnership with Sunflower. If you have questions about this bulletin or other provider resources, please contact your provider network specialist or call Customer Service at toll free 1-877-644-4623.