RADMD | Sunflower Health Plan

Welcome to the Sunflower Health Plan page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent 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 Engagement Manager:

Charles Allison (Advanced Imaging/Cardiology)
Sharee Adams (Interventional Pain Management/Musculoskeletal/Physical Medicine)

MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process.

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 Health Plan - Appeals Department

P.O Box 10287

Van Nuys, CA 91410-0287

Fax: 1-888-453-4755

Advanced Imaging Program

For access to our Advanced Imaging tip sheets/checklists, click here.

Interventional Pain Management Program

For access to our Interventional Pain tip sheets/checklists, click here.

Musculoskeletal Program

For access to our Musculoskeletal tip sheets/checklists, click here.

Physical Therapy 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
Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.

Sunflower Health Plan