Ambetter from Sunflower Health Plan
Welcome to the Ambetter from Sunflower Health Plan page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc.) is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.
If you have any questions about our programs, please contact your dedicated Evolent Provider Relations Manager, Andrew Dietz.
Please note:
Starting on July 12, 2021, Sunflower Health Plan reviews all Medicaid appeals. All Medicaid advanced imaging and physical medicine authorization requests will still be processed by Evolent. In the event of an adverse benefit determination, please follow the instructions in the letter and send your appeal request directly to Sunflower Health Plan. This will ensure the appeal is handled and processed in a timely manner.
Sunflower Appeals Department
8325 Lenexa Drive, Suite 410
Lenexa, KS 66214
Phone number: 1-877-644-4623, TTY 711
Fax: 1-888-453-4755
Advanced Imaging Program
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix - 2024
- Utilization Review Matrix - 2025
For access to our Advanced Imaging tip sheets/checklists, click here.
Interventional Pain Management Program - Effective 4/1/2024
- Frequently Asked Questions
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix - 2024
- Utilization Review Matrix - 2025
For access to our Interventional Pain Management tip sheets/checklists, click here.
Musculoskeletal Program - Effective 4/1/2024
- Frequently Asked Questions
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix (Hip, Knee, and Shoulder) - 2024
- Utilization Review Matrix (Hip, Knee, and Shoulder) - 2025
- Utilization Review Matrix (Spine) - 2024
- Utilization Review Matrix (Spine) - 2025
For access to our Musculoskeletal tip sheets/checklists, click here.
Physical Medicine Program
For access to our Physical Medicine tip sheets/checklists, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
Clinical Guidelines
- Clinical Guidelines
- Click here to view Evolent's Physical Medicine guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.