Ambetter from Sunflower Health Plan
Welcome to the Ambetter from Sunflower Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Andrew Dietz.
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 NIA. 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
Advanced Imaging Program
- Utilization Review Matrix-2022 +0722T & +0724T will be effective 10/01/2022
- Quick Reference Guide
- Frequently Asked Questions
- Provider Education Presentation
- Prior Authorization Checklist
- Tip Sheet
- Pediatric Imaging Tip Sheet
- Peer-to-Peer Process
Physical Medicine Program
- Physical Medicine Frequently Asked Questions
- Physical Medicine Quick Reference Guide
- Physical Medicine Checklist
- Physical Medicine Provider Education Presentation
- Physical Medicine Recording of Provider Training
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
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Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
2013 Jimmo vs Sebelius Settlement Agreement
Click here for information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).