Comprehensive Payment Integrity: Effective September 1, 2026

By August 31, 2026: Billing team must establish a process to rapidly respond to documentation requests from Sunflower Health Plan within the timeframe specified in their detailed instructions. Implement a tracking system to monitor all prepayment review requests and ensure medical records, provider orders, clinical documentation, and billing support are submitted promptly. Train billing staff and providers on the new review process. Update billing procedures to ensure all claims include provider orders in medical records and complete clinical documentation supporting diagnosis and services billed. Establish escalation protocol for disputed review results. Failure to submit requested documentation will result in technical claim denials until required information is received.