Ambetter & Wellcare By Allwell Policy Update for September 2022

Date: 07/29/22

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

We would like to inform you of a new Ambetter (Marketplace) and Wellcare By Allwell (Medicare) policy. Sunflower Health Plan will be implementing the following payment policy, effective on or after September 1, 2022.

CC.PP.066 Leveling of Care: Evaluation & Management Over-coding - The purpose of this policy is to ensure that the level of E&M service reported by the provider reflects the services performed.  When a provider submits an E&M service that exceeds the maximum level of E&M service based on the diagnosis and other claim documentation elements, the E&M code is reduced to reflect the maximum level of E&M service.

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 Provider Services at 1-844-518-9505 (TTY 711)
• Wellcare By Allwell Provider Services at: 
  • HMO 1-855-565-9519
  • HMO D-SNP 1-833-402-6707
  • PPO 1-833-696-0634
  • TTY 711