SHPBN-2019-029 Allwell Referral Requirement Announcement

Date: 08/07/19

Effective September 1, 2019, Allwell from Sunflower Health Plan will no longer require an active referral from the primary care physician (PCP) for Medicare members to access an in-network specialist in one of the following specialty areas:

• Cardiology
• Gastroenterology
• Orthopedic surgery
• Dermatology
• Rheumatology

In-network specialists' claims submitted with a date of service September 1, 2019, or after will not require a referral in order to be paid. If you have a referral in process/pending, and the date of service is September 1 or after, you will not receive a referral authorization, as it is no longer required.

Any Medicare member seeking care from an out-of-network PCP or specialty care provider will continue to require prior authorization, which is subject to medical necessity review.

The PCP is the cornerstone of Allwell's delivery model and serves as the "medical home" for our members. While an active referral to a specialist will no longer be required, the PCP is still responsible for coordinating the member's care to improve health outcomes. This includes but is not limited to, identifying specialist care when medically necessary.

Thank you for continuing to help improve the lives of our members, one member at a time!