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
| Reconsideration (Optional Step) | Appeal | External Independent Third-Party Review (EITPR) | State Fair Hearing | |
|---|---|---|---|---|
| Deadline to Submit | Within 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.