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Policies in the Coordinated Care Clinical Policy Manual may have either a Coordinated Care or a “Centene” heading. Stay Informed They are used to help identify whether health care services are correctly coded for reimbursement. They are used to help identify whether health care services are correctly coded for reimbursement. Policies in the Sunflower Health Plan Clinical Policy Manual may have either a Sunflower or a “Centene” heading. Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules. C-Reactive Protein Increased & Edema of the Scrotum & Gynecomastia & Hydronephrosis Symptom Checker: Possible causes include Metastatic Renal Cell Carcinoma. Helpful Tools Talk to our Chatbot to narrow down your search. In addition, Sunflower may from time to time delegate utilization management of specific services; in such circumstances, the delegated vendor’s guidelines may also be used to support medical necessity and other coverage determinations. It is most commonly caused by too much influence from estrogen and not enough testosterone. They include, but are not limited to claims processing guidelines referenced by the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual (procedure-to-procedure coding combination edits and medically unlikely edits), Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies based on the appropriateness of health care and medical necessity, and at times state-specific claims reimbursement guidance.All policies found in the Sunflower Health Plan Payment Policy Manual apply with respect to Sunflower Health Plan members. Helpful Tools Each payment rule is sourced by a generally accepted coding principle. If you have any questions regarding these policies, please contact Customer Service and ask to be directed to the Medical Management department.You will need Adobe Reader to open PDFs on this site.You will need Adobe Reader to open PDFs on this site. Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members. Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information. Check the full list of possible causes and conditions now!
Each payment rule is sourced by a generally accepted coding principle. Enroll in a Plan In addition, Sunflower Health Plan may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a service has been correctly coded. Reduction mammoplasty and gynecomastia surgery (PDF) CP.MP.126: Sacroiliac joint fusion (PDF) CP.MP.166: Sacroiliac Joint Interventions for Pain Management (PDF) CP.MP.146: Sclerotherapy for Vericose Veins (PDF) CP.MP.165: Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management (PDF) CP.MP.182 Sunflower utilizes InterQual® criteria for those medical technologies, procedures or pharmaceutical treatments for which a Sunflower clinical policy does not exist. Doctors Lounge Membership Application Enroll in a Plan
Other policies (e.g., clinical policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Payment Policy Manual is payable by Sunflower Health Plan.
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