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 (PDF) - Any changes in address, telephone and fax numbers, NPI numbers, and provider status (moved out of area, retiring, capacity changes, etc.) for must be communicated to Sunflower through this form.
- BH Provider Change Form - Any changes in address, telephone and fax numbers, contacts, billing information, and provider status (moved out of area, retiring, capacity changes, etc.) for behavioral health providers must be communicated to Sunflower through this form.
- Preferred Sunflower Roster Format (Excel) - 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.
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
- BH Facility/Agency Roster Template and Instructions (Excel) - Any BH practitioner additions, terminations or changes for multiple practitioners must be submitted to Sunflower Provider Relations via email using this template only.
- Fillable CAQH Provider Data Form and Instructions (PDF) - 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 (PDF) - 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.
- KanCare Credentialing Documents
- Standard Credentialing Application
- HCBS Supplemental Form
- KanCare Credentialing FAQs (PDF)
- Fillable W-9 Form (PDF)
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.