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SHPBN-2019-020 Electronic Claim Appeal Functionality on Secure Portal

Date: 04/22/19

Sunflower is happy to announce the addition of online claim appeal functionality through the secure provider portal effective March 21, 2019. Please note that a secure login is required.

Use the Claim Appeal button within the Provider Portal to submit Claim Appeals

To submit an online claim appeal, log into the Secure Provider Portal.

  1. Search for the claim that you would like to appeal.
  2. Click the Appeal Claim button.
  3. Complete the steps on the screens.
  4. Attach the Provider Reconsideration and Appeal Form and any additional documentation. Please do not password-protect attachments. The portal is secure so a password is not required.
  5. Click Submit.

To submit an online claim reconsideration, log into the Secure Provider Portal

  1. Click Messaging button at the top of the screen.
  2. Click Create Message button.
  3. Choose Reconsideration for subject from drop down list
  4. Provide member ID and date of birth in designated fields
  5. Provide instructions or additional information for reconsideration request in message box
  6. Click Send

Please note that this functionality is currently available for Kansas Medicaid medical claims. The functionality is not yet available for Kansas Medicaid behavioral health claims, nor Allwell or Ambetter claims.

The Provider Reconsideration and Appeal Form can be found on the Manuals, Forms and Resources page.

If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.