Manuals, Forms and Resources
Ambetter from Sunflower Health Plan
Health Insurance Marketplace
Please see the Ambetter from Sunflower Health Plan website.
Wellcare By Allwell
Medicare Advantage Prescription Drug Plan
- Visit Sunflower's Wellcare By Allwell website.
- Provider resources, forms and manuals can be found here.
KanCare - Medicaid
Join us for our Project ECHO series!
Project ECHO is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide best-practice specialty care and reduce health disparities. ECHO trains primary care clinicians to provide specialty care services. This means more people can get the care they need.
Read more and plan to attend an upcoming Sunflower Project ECHO!
- Sunflower Provider Office Manual (PDF) - Updated May 24, 2024
- Centene Dental Services Provider Manual (PDF) (formerly Envolve Dental)
- Centene Vision Services Provider Manual (PDF) (formerly Envolve Vision)
- Evolent (NIA) Provider Handbook (Imaging, PT/OT/ST, Musculoskeletal)
- ModivCare/LogistiCare (PDF) - transportation
Our vendor affiliates manage benefits like vision, dental, pharmacy, transportation, OT/PT/ST, radiology.
Authorizations, Claims & Payment
- 837 EDI Companion Guide - Now included in the Provider Office Manual.
- CARC/RARC Crosswalk (PDF) - Claims EX (Explanation) codes from the remittance advice to the CARC (Claims Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) on the Healthcare Claim Payment/Advice (835). These and other lists can also be found on the X12 website.
- Coordination of Benefits Entry Walk-Through Guide (PDF)
- Corrected Claims Quick Reference Guide (QRG)
- DRG Reviews Presentation (PDF) - from Oct. 2, 2018, webinar
- Member ID Card Reference Sheet (PDF) - Examples of Sunflower member ID cards for Medicaid, Medicare and Marketplace
- KAN Be Healthy (KBH) and Early and Periodic Screening, Diagnostic, Treatment (EPSDT) Billing and Coding Tips (PDF)
- New Century Health - For members 21 years of age or older, authorizations for oncology agents listed on the KDHE Prior Authorization Criteria for Oncology Agents and Auxiliary Treatment Agents require review by New Century Health.
Quality of Care
- Provider Quick Reference Guide (QRG) (PDF)
- Appointment Availability and Wait Times
- Adult Provider Visit Guide (PDF)
- Chasing the Chart (PDF) Information about medical records requests.
- HEDIS Guides and FAQs
- KAN Be Healthy (KBH) and Early and Periodic Screening, Diagnostic, Treatment (EPSDT) Guide
- KDHE Smoking Cessation (PDF) - HUD housing is now smoke-free. Tips to help members quit tobacco.
- Mental and Physical Health (PDF) - Member-facing information about whole-person health
- Preventive and Clinical Practice Guidelines
- Quality Care Pointers for Providers (PDF) (PDF reference resource)
- Pregnancy Quick Reference Guide for Providers
- Telehealth Best Practices - From HHS
HCBS & Behavioral Health
- Consumer Access Guide to HCBS Services in Kansas – From KDADS Community Services and Programs Commission
- In-Home Assessments
- Kansas Psychotropic Medication Utilization Parameters for Children and Youth in Foster Care - This clinical guideline is intended to provide principles to guide prescribing of mental health medications for youth in Kansas and does not supersede provider clinical judgment. In addition, the parameters may differ from Kansas Drug Utilization Review Board drug coverage guidelines.
- PCSP and Completing the PCSP Signature Addendum (PDF) - direction on completing the Person Centered Service Plan. This process is for services not billed through AuthentiCare.
Forms
General Forms
- PCP Change Form
- 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.
- Member Dismissal Form (PDF)
- Unsolicited Overpayments, Refunds Worksheet (XLS) - Providers have the responsibility to report “unsolicited” overpayments or improper payments to Sunflower Health Plan. (See the related bulletin.)
- EPSDT Medical Necessity Form (PDF)
Consent Forms
- Abortion Necessity - Opens on KMAP page, under the Consent heading
- Consent for Sterilization - Opens on KMAP page, under the Consent heading
- Hysterectomy Necessity (PDF)
Authorization Forms
- Inpatient Prior Authorization Form (PDF)
- Outpatient Prior Authorization Form (PDF)
- Outpatient Prior Authorizaton (PA) Supplemental Form (PDF) This is an optional page meant to be used in conjunction with the Sunflower Outpatient Prior Authorization form when a request exceeds more than four procedure codes. This page shoul never be submitted alone.
Pregnancy and Birth Forms
- Notification of Pregnancy (PDF) (System form available through provider portal)
- Birth Event Outcomes Notification (PDF) - Optional form to report birth events/outcomes.
Other Forms
- Integrated Life Plan (PDF)
- Care Grant Request Form (PDF) - used to request care grants for foster care members.
- Lock-In Beneficiary Referral (PDF)
General Forms
- Member Dismissal Form (PDF)
- Unsolicited Overpayments, Refunds Worksheet (XLS) - Providers have the responsibility to report “unsolicited” overpayments or improper payments to Sunflower Health Plan. (See the related bulletin.)
- EPSDT Medical Necessity Form - Opens on KMAP page, under KBH - EPSDT heading
BH Forms
- Discharge Consultation Documentation (PDF)
- Behavioral Health UM Inpatient Request (PDF) - use this form for all KanCare MCOs.
- PRTF Concurrent Review Form (PDF) - Psychiatric Residential Treatment Facilities (PRTF) CCR form
Authorization Forms
- Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
- Neuropsychological Testing Authorization Request Form (PDF)
- Outpatient Psychological Testing Authorization Request Form (PDF)
- Outpatient Treatment Request Form (PDF) - Behavioral health
- Transcranial Magnetic Stimulation (TMS) Request Form (PDF)
- SUD Services Request Form (PDF)
- Psychiatric Residential Treatment Facilities (PRTF) Prior Authorization Request (DOCX)
- Autism Authorization Request Form (PDF)
- Prior Authorization for Supported Housing Operation Community Integration (OCI) Program (PDF)
- Parent Management Training Oregon Request Form (PDF)
- Express Scripts MAC Pricing Inquiry Form
- Synagis PA Form (PDF)
- Other pharmacy forms - including medication and biopharmacy medication request forms
- DME Invoice Pricing Supplemental Form - Find the form under the DME heading.
- EPSDT Medical Necessity Form - Opens on KMAP page, under KBH - EPSDT heading
OneCare Kansas
OneCare Kansas is a Medicaid option for some members to receive coordination of physical and behavioral health care with long term services and supports.
OneCare Kansas expands upon medical home models to include links to community and social supports. OneCare Kansas focuses on the whole person and all of his or her needs to manage his or her conditions and be as healthy as possible. All the caregivers involved in a OneCare Kansas member’s health communicate with one another so that all of a patient's needs are addressed in a comprehensive manner.
OneCare Kansas is intended for people with certain chronic conditions, like diabetes, asthma, or mental illness. These people must be KanCare members. They can be members who also receive Medicare along with Medicaid.
Visit the KanCare OneCare Kansas page to learn more.
Resources
Interpreter Services - Providers may call Sunflower directly or direct members to contact Sunflower to arrange for interpreter services.
Need help to identify your patient's language? We've created this Language Identification Tool (PDF) to help!