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On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.

Vendor Affiliates

Our vendor affiliates manage the benefits below.

  • Envolve Dental: Envolve Dental's Provider Portal
  • Express Scripts: Express Scripts Pharmacy Provider Portal
  • Envolve Vision: Envolve Vision Provider Portal
  • ModivCare (Transportation - Formerly LogistiCare): ModivCare/LogistiCare Provider Portal
  • New Century Health (Oncology):
    • AMBETTER: Oncology & supportive medications for members age 18 and older need to be verified by New Century Health.
    • SUNFLOWER MEDICAID: Beginning May 10, 2021, Oncology & supportive medications for members age 21 and older need to be verified by New Century Health.
  • Evolent (NIA) Imaging: Sunflower Health Plan has contracted with Evolent (formerly NIA) for radiology benefit management.

    The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

    Sunflower Health Plan oversees the NIA program and is responsible for claims adjudication. NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities.

    Prior authorization is required for the following outpatient radiology procedures:
    • CT/CTA/CCTA
    • MRI/MRA
    • PET Scan

KEY PROVISION:

Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim.

Go to the Evolent website for more information.

  • Evolent (NIA) Outpatient Physical Medicine Services (Physical, Occupational And Speech: Therapy)

    Based on provider feedback, Sunflower Health Plan is making changes to authorization requirements related to Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) services for dates of service on and after April 1, 2024.

See Sunflower Bulletin SHPBN-2024-005 or the Sunflower page on Evolent's website for more details.

Beginning January 1, 2021, Evolent (NIA) will provide utilization management for outpatient rehabilitative and habilitative physical medicine services on behalf of Ambetter from Sunflower Health Plan membership in Kansas.

  • Evolent (NIA) (Musculoskeletal): Effective April 1, 2024, Sunflower is expanding its partnership with Evolent (NIA), to provide utilization management services for the Musculoskeletal (MSK) Management program (orthopedic surgery and pain management).

    See Sunflower Bulletin SHPBN-2024-007 or the Sunflower page on Evolent's website for more details.