Manuals, Forms and Resources
- Sunflower Provider Office Manual
- Dental Health & Wellness (DHW) Provider Manual (Dental)
- Envolve Vision (formerly OptiCare) Provider Manual (Vision)
- Envolve Pharmacy Solutions (formerly US Script) Provider Manual (Pharmacy)
- NIA Imaging Provider Handbook (Imaging)
- Cenpatico Provider Manual
- Provider Quick Reference Guide - At-a-glance information about claims appeals, specialty services, fax numbers, and more.
- Corrected Claims Quick Reference Guide (QRG)
- HEDIS FAQs
- Quality Care Pointers for Providers (PDF reference resource)
- 837 EDI Companion Guide - Refers to the implementation guides based on the HIPAA Transaction ASC X12N.
- Provider Post-Service or Claim Dispute/Appeal Process REFERENCE GUIDE
- EPSDT Provider Reference Kit
- Specialty Therapy & Rehab Services Prior Authorization Training Guide
- Medical Necessity Guidelines – Outpatient Physical, Occupational and Speech Therapy
- Abortion Necessity
- Consent for Sterilization
- Lock-In Beneficiary Referral
- Notification of Pregnancy (Fillable form available through provider portal)
- Office Visit Checklist - English | Spanish - Give this to your patients before their appointments to help create a more thorough conversation and encourage patients to plan ahead and focus on any health changes or issues.
- PCP Change Form - English | Spanish
- Inpatient Prior Authorization Form
- Outpatient Prior Authorization Form
- Integrated Life Plan
- ECT Authorization Fax Form
- IOP Authorization Fax Form
- Neuropsych Test Request Fax Form
- Outpatient Physical, Speech, and Occupational Therapy Treatment Request Fax Form
- Claim Dispute Form - To be replaced with new Provider Reconsideration and Appeal Form before May 1.
- Authorized Representative Designation Form
- Envolve Pharmacy Solutions MAC Pricing Inquiry Form
- Synagis PA Form
- Other pharmacy forms - including medication and biopharmacy medication request forms.
For all changes and/or updates, please reference the provider change form instruction sheet before submitting any of the below forms.
- Fillable Provider Change Form and Instructions - Any changes in address, telephone and fax numbers, NPI numbers, and provider status (moved out of area, retiring, capacity changes, etc.) must be communicated to Sunflower through this form.
- Preferred Sunflower Roster Format - Any practitioner additions, terminations or changes for multiple practitioners must be submitted to Sunflower Provider Relations via email. Note: For delegated credentialing, the CAQH number is not necessary on the Sunflower Roster. Please use the Preferred Delegated Sunflower Roster Format
How to complete the Sunflower Roster Form:
- Click the above “Sunflower Roster Format” hyperlink
- Select “Save” to save to your computer
- Locate and open the saved Roster from download
- Review “Important Notes” tab
- Complete all applicable fields in yellow “Roster Form” tab
- Save and email to Sunflower Provider Relations
- Fillable CAQH Provider Data Form and Instructions - Alternative to the Sunflower Roster Form. For practitioners who are already registered on CAQH, additions may be submitted on a CAQH provider data form. Only provide information for one practitioner per CAQH Provider Data Form.
- Fillable KMAP Disclosure of Ownership and Controls Form - Group providers not a part of a health system are required to submit a Disclosure of Ownership form for each practitioner being added to the group.
- Standard Credentialing Application Form
- Fillable W-9 Form
Practitioners have the right to obtain the status of their application at any time throughout the credentialing process and the right to review information submitted to support the credentialing application. Practitioners also have the right to correct erroneous information, should any information obtained from other sources vary substantially from the information provided with the application. Should that occur, you will be notified by the Sunflower Health Credentialing Department and will have thirty (30) days to correct the information. To obtain credentialing status, or if you have questions about these rights, please contact the Sunflower Contracting Department at 1-877-644-4623.