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DRG Post-Pay Audits to be Implemented in Kansas

Fecha: 06/09/24

Diagnosis Related Group Post-Pay Audits

A Message for All Providers. Please share with your administrative team.

Thank you for your continued partnership with Sunflower Health Plan. 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 an additional review process that will taking place beginning on or after October 7, 2024.

DescriptionLine of Business

Sunflower Health Plan will begin auditingselected claims and associated medical records to ensure payments were appliedin accordance with national correct coding standards and DRG payment rules. 

Medical records will be requested for selectedclaims by both our internal review team and our contracted partner Cotiviti.Please ensure medical records are sent according to the instructions on therequest correspondence. 

Medicare, Medicaid, Marketplace


Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at: