Electronic Transactions

Sunflower Health Plan is committed to providing our participating providers with the best tools possible to support their administrative needs. Our electronic transactions capabilities will speed up the processing and payment of your claims.

PaySpan

Sunflower Health Plan and PaySpan are in partnership to provide an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs).

Secure Web Portal

Partial list of secure website functions include verify member eligibility, check/submit claims and submit/confirm authorizations.

EDI

Electronic Transactions (EDI) support for HIPAA transactions is provided for the health plan by Centene Corporation. Centene is currently receiving professional, institutional, and encounter transactions electronically, as well as generating an electronic remittance advice/explanation of payment (ERA/EOP). To conduct other HIPAA transactions not listed, please contact our EDI department at 1-800-225-2573, ext. 607-5525.

The following list contains contact information for the trading partners currently active with our health plan. All providers are encouraged to contact one of these trading partners to utilize our electronic transaction options.

Resources

  • 837 EDI Companion Guide - Refers to the implementation guides based on the HIPAA Transaction ASC X12N. HIPAA x12 Transactions Standard Companion Guide. Find this guide in the Provider Office Manual.

Optometrists and Ophthalmologists (HCFA1500 or 837p Claims):

Claims submitted by Optometrists and Ophthalmologists can be submitted electronically. Information on submission of claims to Envolve Vision can be found on their website at visionbenefits.envolvehealth.com

If the provider chooses to submit electronic claims through KMAP, there is no requirement to submit using a separate payer ID, the claims will be routed appropriately to Envolve Vision.

Dental Providers (Dental Claim Forms or 837d Claims):

Dental claim forms can be submitted electronically.  Information on submission of claims to Envolve Dental can be found on their website at dental.envolvehealth.com.

If the provider chooses to submit electronic claims through KMAP, there is no requirement to submit using a separate payer ID, the claims will be routed appropriately to Envolve Dental.

All Other Medical and Behavioral Health Providers (837i or 837p Claims):

Providers can submit electronic claims in multiple ways:

  • Batch or Direct Data Entry: Via the secure provider portal
  • Via KMAP’s Clearinghouse
  • Via a Clearinghouse Partnered with Sunflower Directly:
    • Payer ID:
      • 68069 – Medical
      • 68068 – Behavioral
    • Clearinghouses:
      • Availity
      • Emdeon
      • Gateway EDI
      • Smart Data Solutions
      • SSI

For submission of electronic 837 medical (837p and 837i) claims directly to Sunflower (not using a clearinghouse) please contact our EDI Help Desk at EDIBA@centene.com or (800) 225-2573, ext. 607-5525.

If you have any questions, please contact:

Sunflower Health Plan
c/o Centene EDI Department
(800) 225-2573, ext. 607-5525

Or by email at EDIBA@centene.com.

To receive Electronic Fund Transfers (EFTs) and Electronic Remittance Advice (ERA – AKA 835), register for PaySpan.