Centene / Sunflower Health Plan
Welcome to the Centene/Sunflower Health Plan page. Here you can download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Website to obtain and check authorizations.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager, Andrew Dietz.
Important Bulletin
Starting on August 1, 2021, Sunflower Health Plan will review NIA Medicaid authorization appeals.
All initial Medicaid high-tech imaging requests for radiology and physical medicine (PT/ST/OT) will still be processed by NIA Magellan. In the event of an adverse benefit determination, please follow the instructions in the letter and send your appeal request directly to Sunflower. This will ensure the appeal is handled and processed timely.
Sunflower Appeals Department
8325 Lenexa Drive, Suite 410
Lenexa, KS 66214
Phone number: 1-877-644-4623, TTY 711
Fax: 1-888-453-4755
If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at 1-877-644-4623.
Update on COVID-19
Documents
- Sunflower Health Plan Utilization Matrix-2021
- Sunflower Health Plan Ordering Provider Quick Reference Guide
- Sunflower Health Plan Rendering Provider Quick Reference Guide
- Sunflower Health Plan FAQ
- Prior Authorization Checklist
- Provider Handbook
- Sunflower Health Plan Provider Resources
Physical Medicine
Effective June 1, 2020, physical medicine services (physical therapy, occupational therapy and speech therapy) will no longer be managed through a post-service review process. Therefore, beginning June 1, 2020, Sunflower Health Plan will implement a prior authorization of outpatient physical medicine services for its membership.
- Physical Medicine Provider Training PPT
- Physical Medicine Announcement Letter
- Physical Medicine Frequently Asked Questions
- Physical Medicine Quick Reference Guide
- Physical Medicine Checklist/Tip Sheet
- Physical Medicine Guidelines
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
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.
Click the link below to see information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.
Clinical Guidelines
- Clinical Guidelines
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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.