Ambetter from Sunflower Health Plan Cardiac Surgical Quality and Safety Management Program in Partnership with TurningPoint

Date: 07/01/25

Ambetter from Sunflower Health Plan is pleased to announce the launch of a new and innovative Cardiac Surgical Quality and Safety Management Program. The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Ambetter from Sunflower Health Plan members undergoing Cardiac Surgical Procedures.

Program Highlights Include:

• Administrative Tools to support an efficient, user-friendly request process for obtaining medical necessity prior authorizations for procedures which require precertification. Easy and efficient post-procedural documentation submission which will be shared with Ambetter from Sunflower Health Plan to facilitate timely claims payment.
• Specialized “Peer to Peer” Engagement where a TurningPoint physician (from the same specialty) engages the provider regarding authorization requests that require additional clinical discussion to validate the clinical appropriateness of the procedure specific to the patient’s needs and current condition.
• Clinical Support Tools to assist in the tracking and monitoring of patient outcomes and education around patient risks and preventive measures to better coordinate care for the member and reduce infection rates and complications due to patient comorbidities.
• Reporting, and Analytics that gives physicians and practice administrators greater visibility and transparency into their performance compared to the practice as a whole, as well as the rest of the market.
• FDA Recall Tracking and Monitoring to facilitate timely and consistent notification to the physician, patient, and to Ambetter from Sunflower Health Plan when a member has received or needs a revision surgery due to a Class I or II FDA device recall.

This correspondence serves as notice under your Participating Ambetter from Sunflower Health Plan Provider Agreement of these program changes, effective Sept. 1, 2025. Physicians can begin submitting prior authorization requests to TurningPoint beginning on Aug. 18, 2025 for dates of service on or after Sept. 1, 2025. While it is the responsibility of the rendering physician to obtain prior authorization, facility providers are encouraged to contact TurningPoint to verify the prior authorization has been complete for Ambetter from Sunflower Health Plan members prior to admission.

The program will include the following Ambetter from Sunflower Health Plan Membership: Marketplace

Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to TurningPoint Healthcare Solutions, LLC and will be required for the following surgical procedures in both inpatient and outpatient settings:

CARDIAC SURGERIES & PROCEDURES
Including all associated partial, total, and revision surgeries

TurningPoint’s Utilization Management & Precertification Contact Information:
Web Portal Intake: http://www.myturningpoint-healthcare.com
Telephonic Intake: 785-727-2483 | 877-364-5547
Facsimile Intake: 833-916-1087

Key Provisions:

• Emergency Related Procedures do not require authorization
• It is the responsibility of the ordering physician to obtain authorization
• Providers rendering the above services should verify that the necessary authorization has been obtained; failure to do so may result in non-payment of your claims
• Clinical Policies are available by contacting TurningPoint at (877) 364-5547 for access to digital copies

Training:
Informational webinars are available! Please register at: https://us06web.zoom.us/meeting/register/CpbcTqMlSYGBjOKJSfXmHg

We appreciate your support and look forward to your cooperation in assuring that Ambetter from Sunflower Health Plan members receive high quality, cost-effective care for these surgical procedures.

We will provide additional information and training opportunities as we get closer to the effective date of the program. Should you have any questions at this time, please contact Ambetter from Sunflower Health Plan Provider Services Line at 1-844-518-9505 (TTY 711).

Below are listed the CPT and HCPCS codes impacted by this program:

CPT Codes:

0075T, 0076T, 0483T, 0484T, 0571T, 0572T, 0573T, 0574T, 0580T, 0795T, 0796T, 0797T, 0798T, 0799T, 0800T, 0801T, 0802T, 0803T, 0823T, 0824T, 0825T,  0861T, 0862T, 0863T, 33202, 33203, 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33221, 33224, 33225, 33227, 33228, 33229, 33230, 33231, 33233, 33236, 33237, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33274, 33275, 33285, 33286, 33340, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33405, 33406, 33410, 33411, 33412, 33413, 33418, 33419, 33430, 33440, 33465, 33475, 33477, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33572, 35302, 35303, 35304, 35305, 35371, 35372, 35556, 35558, 35566, 35571, 35583, 35585, 35587, 35656, 35661, 35666, 35671, 35700, 35881, 35883, 35884, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, 37236, 37237, 37238, 37239, 37246, 37247, 37248, 37249, 4110F, 92928, 92929, 92933, 92934, 92937, 92938, 92943, 92944, 93745, 92920, 92921, 92924, 92925, 0913T, 0914T, 93580, 93653, 93654, 93656

HCPCS Codes:

C1721, C1722, C1764, C1777, C1779, C1785, C1786, C1874, C1875, C1876, C1877, C1880, C1882, C1895, C1896, C1898, C1899, C1900, C2617, C2619, C2620, C2621, C2623, C2625, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608, E0616, G0448, K0606, S2205, S2206, S2207, S2208, S2209, C1605, C7564, C9610

Sincerely,

Ambetter from Sunflower Health Plan