Ambetter Policies Update for March 2022

Date: 01/19/22

Thank you for your continued partnership with Ambetter from Sunflower Health Plan. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members.

We are writing today to inform you of new Ambetter Marketplace policies. Sunflower Health Plan will be implementing the following payment policies and clinical policies that have payment implications, effective March 1, 2022.

• CP.MP.209 Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing - Restricts reimbursement of GI pathogen panels with 12+ targets to only inpatient settings, including inpatient, ED, and outpatient hospitals.
• CC.PP.071 Evaluation and Management Services Billed with Treatment Rooms - Disallows E&M services in treatment rooms as this does not represent a treatment type of service.
• CC.PP.070 340B Drug Payment Reduction - Ensures that providers participating in the 340B Drug Pricing Program are correctly reporting 340B acquired drugs according to guidelines established by the Centers for Medicare and Medicaid Services (CMS).

For detailed information about these policies, please refer to our Clinical and Payment Policies page.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Ambetter from Sunflower Health Plan (Marketplace) Provider Services at 1-844-518-9505 (TTY 711).