FAQs

If you have questions not covered below, please call us at 1-877-644-4623 (TTY: 711).

ADA

No, the ADA surveys are basic and nothing different than providers’ normal requirements.

Advance Directive

Sunflower is committed to ensuring members are aware of and are able to avail themselves of their rights to execute Advance Directives. Sunflower is equally committed to ensuring participating providers and their staff are aware of and comply with federal and state laws regarding Advance Directives; and that the Sunflower Medical Management staff are trained on our policies and procedures related to Advance Directives.

PCPs and providers delivering care to Sunflower members must ensure members age 18 years and older receive information on Advance Directives and are informed of their right to execute an Advance Directive. Providers must document such information in the patient’s permanent medical record. See the Provider Manual for a list of recommendations for providers.

AuthentiCare

Yes. The State has provided current provider Medicaid ID numbers.  These Medicaid ID numbers will be cross walked in the Sunflower claims system in order to match AuthentiCare claims without the NPI number.

Authorization

The services that require Prior Authorization can be found in the Provider Manual as well as posted in the Resources Section. Additionally, Sunflower offers a procedure lookup tool on our website. You can enter a CPT, HCPCs, or UB04 code to check for authorization requirements.

Sunflower has adopted utilization review criteria developed by McKesson InterQual® products to determine medical necessity for healthcare services. InterQual appropriateness criteria are developed by specialists representing a national panel from community-based and academic practice.

InterQual is utilized as a screening guide and is not intended to be a substitute for practitioner judgment. The Medical Director, or other healthcare professional that has appropriate clinical expertise in treating the member’s condition or disease, reviews all potential adverse determination and will make a decision in accordance with currently accepted medical or healthcare practices, taking into account special circumstances of each case that may require deviation from the norm in the screening criteria.

The member and provider are required to follow the rules of the primary payor. If the primary payor denies for administrative reasons, Sunflower will NOT coordinate with the primary insurance. If the primary payor denies for non-administrative reasons, the provider will be required to obtain an authorization for any service Sunflower would otherwise require an authorization if Sunflower had been the primary payor.

Yes.

Yes.

Yes.

The member and provider are required to follow the rules of the primary payor. If the primary payor denies for administrative reasons, Sunflower will NOT coordinate with the primary insurance. If the primary payor denies for non-administrative reasons, the provider will be required to obtain an authorization for any service Sunflower Health Plan would otherwise require an authorization if we were the primary payor.

Generally speaking, nursing facilities will receive an authorization for 3 months.

No. Long Term Care centers should use the Inpatient Fax Form on the Sunflower website.  There is a box to indicate that the site is a Long Term Care center.

Behavioral Health

Cenpatico will post a cross-walk to the new codes.  This will be posted on the Cenpatico and Sunflower website.  The actual fee schedule will not be posted.

The Manual is currently posted on both the Sunflower and Cenpatico websites.

Yes.

Please refer to the Authorization Guidelines in the Cenpatico Provider Manual.

Yes.

Yes. Please see the Cenpatico Provider Manual for additional details.

Yes. These materials are on the websites for both Sunflower and Cenpatico.

Yes, if you are a registered user on the Cenpatico secure provider portal.

Billing

Sunflower’s website displays all provider bulletins on the Provider Resources page. For immediate updates related to billing and claims payments, it’s important to sign up for the Email Alerts. Providers can subscribe to Sunflower’s email alerts through this website.

Case Management

Yes.

Please fax to 1-877-851-3990.

Claim Payment

Sunflower accepts electronic claims, claims submitted through our Secure Provider Portal or claims submitted through KMAP.

Sunflower utilizes payer ID number 68069. Our preferred electronic claims warehouses are: SSI, Gateway, Emdeon, Availity, and Smart Data Solutions.

Additionally, single or batch claims can be submitted free of charge through our Secure Web Portal. The registration process for the Secure Web Portal takes about 5 minutes.

Paper claims are submitted to Sunflower or its benefit managers, depending on the service. Please see the Provider Manual or Provider Quick Reference Guide for specific information.

Providers must submit the Rendering Provider NPI to avoid claim rejection.

Sunflower has scheduled check runs two times a week.  Our average claims payment turnaround time is 7 to 14 days for clean claims.

Yes.

No, only that line item will deny.

Yes.

Nursing assessments under the TA waiver have coverage of one (1) every three (3) months and  the FE waiver one (1) per lifetime.  Wellness monitoring has coverage for one (1) every fifty five (55) days under the FE waiver.  These services require authorization.

Yes, unless the Provider’s contract specifies that overpayments should be handled in a different manner.

Yes, clearinghouses not on our list will route the claims to Avility which will send the claims on to Sunflower.

Generally no, however HCBS providers who submit claims via Authenticare do require a Kansas Medicaid ID number to use that system and to receive payment from Sunflower Health Plan. For assistance with obtaining an expedited Medicaid ID, please contact 1-877-644-4623 (TTY: 711) and follow the prompts to Provider Contracting.

Contracting

Go to Contract Request Form. This form will ask you to complete some very basic information. You may also call us at 1-877-644-4623 (TTY: 711) to request a contract.

Generally no, however HCBS providers who submit claims via Authenticare do require a Kansas Medicaid ID number to use that system and to receive payment from Sunflower Health Plan. For assistance with obtaining an expedited Medicaid ID, please contact 1-877-644-4623 (TTY: 711) and follow the prompts to Provider Contracting.

Co-Pays

No, there are no co-pays for KanCare. However, some members have to cover a Spenddown requirement.

Credentialing

Yes.

Yes, you must be credentialed by Sunflower. Upon your written authorization, Sunflower will access your credentialing information on the CAQH (Council for Affordable Quality Health) website. Sunflower will also use the Kansas Final Joint Approved Credentialing Application for hospitals and ancillary providers. These documents will be included in the contract packet sent to you by Sunflower.

DRG Audits of Hospitals

A special list of Frequently Asked Questions and Answers about iCRS have been posted here: ICRS DRG Audit FAQs 2014.

Education

Yes.  Sunflower and Cenpatico Provider Relations teams are available to conduct orientations or in-service sessions.  Please contact Provider Relations at 1-877-644-4623 (TTY: 711).

Members can change their MCO during their 90 days of eligibility/assignment, then once/year during open enrollment. Members can change their PCP/providers at any time. To view Sunflower's provider directory, please click here.

Eligibility

Yes, only members under SSI, HCBS, and LTC.

Members are auto-assigned to MCOs by the State. Claims for newborn services billed under the mother’s beneficiary ID will be pended for 45 days pending receipt of the newborn’s beneficiary ID number. If a newborn ID is received, the claim will be denied EXnB – Deny: Rebill with Newborn Medicaid ID#, Name and DOB notifying the provider they must submit a corrected claim using the newborn’s ID number, name and DOB.

If no newborn ID is received and the date of service is within 45 days of the newborn’s date of birth, the claim may be paid using the mother’s ID number. If the date of service is not within 45 days of the newborn’s date of birth, the claim will be denied.

Members assigned retroactively must follow the instructions in bulletin SHPBN-2016-013: Retro Eligibility Notification Process.

FMS

HCBS services require an approved plan of care and resulting prior authorization.

FMS providers may verify eligibility and view claims payment status.

Form 2126

Yes, nursing facilities should follow the same process that exists today.  Continue to submit the form to the State.

HCBS

Yes.

Health Homes

The KanCare Health Homes program was discontinued on June 30, 2016.

Members' physical and behavioral health care services will continue under KanCare.

Health Plan

Sunflower Health Plan is a Medicaid Managed Care Organization (MCO) contracted with the Kansas Department of Health and Environment (KDHE) – Division of Health Care Finance (DHCF) to serve Medicaid eligible members through the KanCare Program effective January 1, 2013.

Sunflower is a subsidiary of Centene Corporation which has over 27 years of experience in the Medicaid industry.

Upon completion of the contracting and credentialing process, you will be notified of your contract effective date and will receive a Provider Welcome Packet. This Packet will include a copy of the Provider Manual, the Billing Manual, Quick Reference Guides and other helpful forms.

Each office, hospital, clinic, and ancillary provider will be assigned a dedicated Provider Relations Specialist. Your Provider Relations Specialist will contact you to schedule an orientation to review the materials in the Provider Welcome Packet.

Your Provider Relations Specialist will schedule periodic visits with you. In between the visits, you may visit this site for updates.

Additionally Sunflower has a local, dedicated Provider Call Center to assist you with any questions that you might have. The local Provider Services Representatives can be reached at 1-877-644-4623 (TTY: 711) Monday through Friday 8:00 a.m. to 5:00 p.m.

KAN Be Healthy Screen

Yes.

LTC

The ADRC will conduct the CARE Assessment.

PaySpan EFT/ERA

Yes, Sunflower has partnered with PaySpan Health to deliver a web based approach to EFT and ERA. This is a free service to providers. Register on the PaySpan website.

Call PaySpan at 1-877-331-7154 or e-mail them at providersupport@payspanhealth.com.  You must provide your tax ID number. You will then complete the registration process at www.payspanhealth.com.

PaySpan will then send a test deposit to the bank account specified during the registration process. You must verify the receipt of the test deposit and then you will be fully registered.  Electronic Remittance advice will begin immediately. If you have trouble with registration, please visit PaySpan's help page or contact your provider relations representative.

Yes, if the provider is a registered user for PaySpan.

Yes, if the provider has signed both a Sunflower and Cenpatico agreement, the provider will need to register for both. Call PaySpan at 877-331-7154  to receive a registration code and PIN number in order to complete the registration process.

Referrals

Paper Referrals are not required for services at participating/contracted specialists. Members are educated to always consult with their Primary Care Physician before accessing specialty services.

Secure Portal

Member Identification cards will be issued to all Sunflower members. Sunflower strongly encourages you to verify eligibility each and every visit. Eligibility can be verified through the Sunflower Secure Web Portal or by calling Provider Services at 1-877-644-4623 (TTY: 711). Additionally, eligibility may be accessed via the KMAP website.

Once registered on the Portal, you may do the following:

  • Check member eligibility
  • Check to see if prior authorization is needed
  • Submit Prior Authorization Requests
  • View patient lists
  • View, adjust and submit claims
  • View Payment History
  • And more...

You must be a contracted provider or have submitted a least one claim to Sunflower in order to register for the Secure Web Portal.

Yes.

Yes. In fact, we require that each individual have a sign-in rather than sharing a sign-in.

The patient list will be available to PCPs through the secure portal prior to the January 1st Go Live date.

Yes, providers will receive a web reference number to view claim status.

Yes, providers can use the secure portal to correct paper claims, Authenticare claims, EDI claims, or claims submitted through the secure portal.

Specialty Services

Our vendor, Voiance, will provide both face-to-face and over-the-phone interpreter services.

Below are some of the programs Sunflower offers to our members:

  • MemberConnections – in-person interaction and member outreach support
  • NurseWise – 24 toll-free phone access to registered nurses who can answer medical questions and help members determine if their condition is an emergency
  • CentAccount – Rewards based incentives for achieving healthy behaviors and habits
  • Start Smart for Your Baby – Education for pregnant and new mothers on how to grow and stay healthy
  • Connections Plus – Pre-programmed cell phones to high-risk members lacking reliable phone access

Specialty Vendors

Due to their expertise in managing certain services, Sunflower contracts with specialty vendors.

Provider manuals for the health plan and our specialty vendors can be found on the Provider Manuals, Forms and Resources page.

Third Party Liability

If Sunflower has been made aware of third party liability, this information will be posted on the eligibility section of our secure web portal.  Please continue to use the State’s TPL Provider Manual.

Transplants

Yes. Transplants are a covered benefit.