Skip to Main Content

News

Durable Medical Equipment, Home Health, & Skilled Nursing Facility – New Audit Program

Fecha: 04/05/26

Thank you for your continued partnership with Sunflower. As you know, we are committed to continuously evaluating and improving overall payment integrity solutions as required by state and federal governing entities. We are writing today to inform you of changes to existing review criteria that will go into place on or after June 1, 2026.

This program is a comprehensive medical record audit to validate the services billed and reimbursed are accurately documented in the provider’s medical records in accordance to policy CC.PI.11 – Payment Integrity Vendor Post Payment Audits (Home Health, SNF and DME).

Sunflower Payment Integrity will implement a post-payment audit for a select sample of network claims each month. To support this process, Sunflower will use an approved vendor, Performant, to complete these audits.

Providers who have a claim selected for post-payment audit will receive written notice of the audit and be asked to supply medical record documentation to Performant to substantiate the services associated with the claim.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call us at the numbers below:


Ambetter from Sunflower Health Plan is underwritten by Celtic Insurance Company, which is a Qualified Health Plan issuer in the Kansas Health Insurance Marketplace. ©2026 Celtic Insurance Company. All rights reserved.