Sunflower State Health Plan- Update and Email Alert Signup

Sunflower State Health Plan would like update all providers with Long term Care/ Nursing Facility entities with the following:

On behalf of Sunflower State Health Plan, thank you for providing services to our members to
help keep them happy and healthy. This bulletin is to inform our nursing facility and long- term
care providers that we have completed system updates and are reprocessing claims to address the
following scenarios:

•    Client Obligation and Patient Liability – claims that did not have the appropriate Client
Obligation or Patient Liability withheld. Providers may experience an adjustment on their
remittance advice showing no change in payment if the original claim withheld Client Obligation or
Patient Liability appropriately.

•    Nursing Facility Rate Changes – all claims paid at the incorrect rate will be reprocessed with
the new rate changes beginning with dates of service January 2013 through December 2013

•    Retro Eligibility – claims identified for members with retro eligibility updates for the time
period Jan 1 through Nov 30 will be reprocessed if an authorization is on file for the date of

•    Medicare Primary – claims that denied for a primary carrier EOB when Medicare is primary for
dates of service January 2013 through December 2013.

The system updates will be implemented on January 17, and the reprocessing of claims will be
completed over the next few weeks.

The 2014 Provider Manual is now available on our website at
under Provider Resources.

Visit our website at to sign up for Sunflower’s email