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SHPBN-2016-076 Unsolicited Refunds Process

Date: 11/08/16

Responsibility to report overpayments or improper payments within 60 days

Sunflower Health Plan routinely audits all claims for payment errors. Claims identified to have been underpaid or overpaid will be reprocessed appropriately. Providers have the responsibility to report “unsolicited” overpayments or improper payments to Sunflower Health Plan. Providers have 60 days from the date of notification to refund “unsolicited” overpayments or to establish a payment plan (when available) before claims are reprocessed. Providers have the right to appeal.

Providers have the option of requesting future off-sets to payments or may mail refunds and overpayments, along with supporting documentation (copy of the remittance advice along with affected claims identified), to the following address:

Sunflower Health Plan
P.O. Box 955889
St. Louis, MO 63195-5889

Providers can submit a letter authorizing recoupment or application of an enclosed check with a spreadsheet with the following supporting documentation:

  • Claim number
  • Service line number
  • Member Name
  • Medicaid ID
  • Patient Control Number (provider’s unique identifier)
  • Date of Service
  • Procedure
  • Billed Amount
  • Paid Amount
  • Paid Date
  • Amount to recoup* required
  • Reason for recoupment* required

Please note that Sunflower cannot recoup claims or coordinate benefits if all other payer’s EOBs are not attached.

Please refer to the provider bulletin on Coordination of Benefits & Third Party Liability https://www.sunflowerhealthplan.com/newsroom/shpbn-2015-037.html

The downloadable spreadsheet is posted on our website.

A sample spreadsheet is below for illustration:

Questions: please contact Customer Service at 1-877-644-4623.

Need help filling out the spreadsheet? Sunflower can fill out all of the columns on the spreadsheet except the amount to recoup and the reason for recoupment. Please email the tax ID and date of service date range to providerrelations@sunflowerhealthplan.com.