Medicare Provider Resources
Wellcare is Sunflower's Medicare Advantage plan. Use the resources below for all plans EXCEPT Wellcare Complete.
Medicare Provider Service
Providers can send us their questions related to Wellcare (Medicare Advantage) through the secure portal messaging function or by using this form.
Provider Manual
Provider Forms
- Inpatient Authorization Form (PDF)
- Outpatient Authorization Form (PDF)
- Outpatient Authorization Supplemental Form (PDF)
- This is an optional page meant to be used in conjunction with the Sunflower's Outpatient Prior Authorization Request form when a request exceeds more than four procedure codes. This page should never be submitted alone.
- Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
- Inpatient Neuropsychological Testing Authorization Request Form (PDF)
- Outpatient Psychological Testing Authorization Request Form (PDF)
- Outpatient Treatment Request Form (PDF)
- Transcranial Magnetic Stimulation (TMS) Request Form (PDF)
- SSBCI Attestations for Chronically Ill Members
- Non-Par Provider Appeal Form (PDF)
- Par Provider Payment Reconsideration Form (PDF)
Other Resources
- Clinical & Payment Policies
- QMB Balance Billing FAQs - information about balance billing qualified medicare beneficiaries
- Medicare Step Therapy Clinical Policy (PDF)
- Premier Eye Care Provider Manual (PDF)
- Medical Necessity Criteria
- Timely Filing Guide
- 2026 Alternative Covered Drugs (PDF)
Training Resources
Orientation Resources
- Wellcare Appeal and Reconsideration Guide 2026 (PDF)
- Wellcare Claims, Disputes, Recovery Guide 2026 (PDF)
- Wellcare Pharmacy Guide 2026 (PDF)
- Wellcare Prior Authorization Guide 2026 (PDF)
- Wellcare Provider Quick Reference Guide 2026 (PDF)
- Wellcare Payspan (Electronic Funds Transfer) (PDF)
- WellcareRisk Adjustment Tips (PDF)
Sign Up for Email Alerts
Sunflower Health Plan sends out regular news and bulletins. Click the "Get Alerts" button below to sign up to receive our news via email.
Medicare Provider News
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