Sunflower Medicaid Provider Manual Revised March 2026

Date: 03/02/26

Revision Now Available

The Sunflower KanCare provider manual has been updated and is now available in the Provider Resources of the Sunflower website.

The manual changes include the following:

Provider Manual Section	What Was Updated?	Page Number
How to Use This Provider Manual	988 Suicide & Crisis Lifeline BH & Transplant PA Fax Number Availity Essentials	Page 5 Page 4 Page 5
Kansas Medicaid Program Summary	Beneficiaries who are not eligible for Managed Care	Page 6
Provider Network Termination	Changed from 90 days to 180 day notification Addition that Network Terminations can be done on KDHE provider enrollment portal	Page 11 Page 12
Travel Distance and Access Standards	Updated KDHE Network Adequacy Standards link	Page 19
Appointment Availability and Wait Times	Update to Routine SUD Provider standard Update to SUD Provider standard	Page 20 Page 20
Member Identification Care	Updated ID Card example	Page 24
Benefit Explanation and Limitations	Change of One routine OB sonogram per Policy E2007-060	Page 30
Value-Added Benefits for Members	2026 VAB Changes	Page 37-40
Prior Authorization Notification	Prior authorizations should be requested at least 5 days prior to the schedule service start date	Page 41
Lock-In	Updated pharmacy fax number	Page 47
Substance Use	Updated Substance Abuse to Substance Use throughout the manual	Page 55
Peer-to-Peer Discussions	Peer-to-Peer reviews should be requested within 3 days of the denial notification. Physical therapy peer-to-peer reviews will be done by physical therapists	Page 50 Page 50
Who Can File Claims	Updated email address for provider changes	Page 57
Fraud, Waste, and Abuse	FWA concerns can also be submitted online	Page 69
Grievance and Appeal Process	Updated mailing addresses for provider appeals and member appeals Updates in accordance with KDHE Policy M2019-116	Page 70 Page 71-77
QAPI Program Structure	Multiple updates based on state Quality Management Strategy Update to Committee names	Page 79 Page 80
Provider Satisfaction Surveys	Provider responses are confidential though the health plan knows which providers were sent a survey	Page 83
Claim Form Instructions	Field 17 – added DME and hospice Field 24d – enter the 5-digit CPT or HCPC code and the 2-character modifier	Page 96 Page 98
HCBS Programs Billing Information	Removed waiver service tables and directing provider to the KMAP Provider Manuals as the source of truth	Page 110
Electronic Visit Verification (EVV) – Kansas AuthentiCare	Updated tables to reflect services that require the use of EVV	Page 111-112

Thank you for your partnership with Sunflower Health Plan. If you have questions about this bulletin or other provider resources, please contact your provider network specialist or call Customer Service at 1-877-644-4623.