Sunflower Health Plan, Centene's KanCare plan, administers the CCTS/IIS autism-services benefit. Its clinical-policy index now lists Centene's CP.BH.104 (ABA, revised 02/26) and CP.BH.105 (ABA documentation) as its Medicaid behavioral health ABA policies; the older Kansas-specific KS.CP.01 (last reviewed 06/2019), with its 6-month diagnosis rule, is still hosted but no longer listed. The working document for intake is the Autism (Non-Waiver) Prior Authorization Request Form, which puts the 97151 assessment itself under prior authorization and carries the uniquely Kansas gate — a KAN Be Healthy (EPSDT) recommendation within the past year. That gate regularly stalls authorizations silently, so it belongs in the first intake conversation.
Sunflower's Autism (Non-Waiver) Prior Authorization Request Form (KDHE-approved 4/15/2025) is the packet. It lists 97151 and 97152 as assessment codes needing authorization, and for the initial assessment asks for comprehensive diagnostic information including standardized measures, a referral for ABA services "that is within one calendar year," and a KAN Be Healthy recommendation within one year. The initial treatment plan adds standardized testing (e.g., Vineland, ADOS, WISC-R, CARS), a criterion-referenced skills assessment (ABLLS, AFLS, VB-MAPP), coordination with school, PT, OT and ST, the proposed schedule and who renders it, goals, a parent-training plan, and the IEP or IFSP if there is one. "Information older than 30 days will be considered outdated." Behind the form, Sunflower's policy index lists Centene CP.BH.104 (revised 02/26) as its Medicaid ABA policy: the behavioral assessment must be done by a BCBA "no more than two months prior to the start of the initial treatment authorization," assessments and treatment plans are updated at least every six months, and more than six hours a day or 30 hours a week needs added clinical justification. The focused (10–25 h/wk) and comprehensive (25–40 h/wk) tiers and the 6-month diagnosis rule come from KS.CP.01 (last reviewed 06/2019), which is still hosted but no longer on the index.[10][1][3][7][8]
The state rule now points the other way on recency. KMAP Bulletin 26140, effective 11/1/2026, requires that for members 20 and under the ASD diagnosis come from a Kansas BSRB-licensed clinical psychologist or a qualified physician, documented against DSM criteria/severity using a validated diagnostic tool (e.g., ADOS, CARS) — and says that once so diagnosed a member is eligible "without the need for a re-evaluation" with "no time limit on how soon they begin autism treatment." Members already in treatment with a non-compliant diagnostician have two years to obtain an updated diagnosis. Two further facts cut against the 6-month rule above: KS.CP.01 itself says state Medicaid provisions take precedence on conflict, and Sunflower's clinical-policy index (checked 9/27/2026) no longer lists KS.CP.01 at all — it lists Centene's CP.BH.104 (revised 02/26), which accepts a comprehensive diagnostic evaluation from the past three years. Until Sunflower says which it applies, ask UM before sending a family for a re-evaluation.[10][1][3][7][8]
The KAN Be Healthy recommendation is on the current PA form twice: for the initial assessment, a "KAN Be Healthy recommendation within one year (A general well-child visit does not meet this. It must also include a developmental screen.)," and for later requests an "Annual KAN Be Healthy recommendation for continued services." Families often need a PCP visit before ABA can be approved, which makes screen status a day-one intake question rather than a submission-day discovery. The ABA referral must also be within one calendar year. Diagnosis age is the open question: the KMAP bulletin says no re-evaluation, CP.BH.104 accepts an evaluation from the past three years, and the legacy KS.CP.01 said six months, so if the report is older, ask Sunflower UM which rule applies before the auth rather than after a denial. Submissions go to fax 844-824-7705 on the form, or through Sunflower's portal.[10][7][1]
Sunflower publishes no rule on transferring an authorization from one ABA agency to another. What its documents do say: authorizations are requested per provider — the PA form names the BCBA/CCTS provider NPI and group NPI and asks "Is this an initial request for authorization?" — and if a new agency's initial assessment was not requested first, "all items in the initial assessment category also must be included with the initial treatment plan." CP.BH.104 lists "The member/enrollee has transitioned to another provider or community resources for alternative treatment" as a ground for discontinuing services with the old provider, and a discharge summary must record referrals, the reason for discharge, the rendering provider's and caregiver's signatures and the discharge date (CP.BH.105). Before the new agency submits, ask Sunflower UM (1-877-644-4623) whether it will authorize a new 97151 while another agency holds an active authorization, and whether it needs the first agency's discharge date.[10][7][11]
Sunflower publishes no ABA network closure or moratorium; its 2026 provider manual describes building "a network of qualified providers/practitioners" to meet KanCare's network adequacy requirements, with the contracting department monitoring adequacy. The route in is fixed: "All providers wishing to participate in the Sunflower KanCare network must enroll through KMAP first," KMAP sends the enrollment to the MCOs chosen "for credentialing and contracting," and "KMAP approval does NOT guarantee participation in the Sunflower network." Group applications include a roster or CAQH form "for each practitioner employed by the provider," and Sunflower commits to credential 90 percent of complete applications within 30 days and all within 45. Ask the Contracting department (1-877-644-4623) whether it is adding ABA providers in your area.[9]
Sunflower publishes no ABA rate table. The sample Medicaid product attachment in its provider manual sets the formula: payment is "the lesser of (i) the billed charge for the particular Covered Service, or (ii) the appropriate amount for such Covered Service under the Company's fee schedule in effect on the date of service," and "Upon Provider's reasonable written request from time to time, the Company will provide Provider with a representative sample of the fees then in effect." The public state benchmark is KMAP Bulletin 24125: 97153 at $65 per hour ($16.25 per 15-minute unit) from 7/1/2024; the bulletin notes MCO implementation "may vary from the date noted."[9][14]
Kansas licenses the practice: “no person shall practice applied behavior analysis in this state unless they are” a licensed behavior analyst, a licensed assistant behavior analyst under LBA supervision, a supervised trainee, or a licensed psychologist (K.S.A. 65-7503(a)). The exemptions cover people providing services under IDEA or Section 504 and providers qualified under the HCBS autism waiver, not out-of-state analysts. The statute does not say in terms whether video sessions with a child located in Kansas are practice “in this state,” so the safe plan is a Kansas LBA (Behavioral Sciences Regulatory Board) before the first remote session.[15][16]
For KanCare, enrollment runs through KMAP. We have not verified KMAP’s rules for enrolling an out-of-state ABA provider, so ask KMAP provider enrollment before treating a KanCare member from another state.[15][16]
Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Sunflower’s network has to be enrolled with Kansas Medicaid (KMAP) as well.[15][16]
Only for extenuating circumstances or retroactive eligibility. Sunflower’s provider manual (KDHE approved February 27, 2026) defines retrospective review as an initial review after services were provided, which “may occur when authorization or timely notification to Sunflower was not obtained due to extenuating circumstances (e.g., member was unconscious at presentation, member did not have his or her Sunflower ID card, services were authorized by another payer who subsequently determined member was not eligible at the time of service).” Requests “must be submitted promptly,” and the decision comes within 30 calendar days, “not to exceed 180 calendar days from the date of service.” For a member awarded retroactive eligibility whose claim was denied, the provider files an optional reconsideration or appeal with documentation of the retroactive enrollment.[9]
Sunflower’s February 2026 manual: "Original provider claims (first-time claims) must be received by Sunflower within 180 calendar days from the date of service"; as secondary payer, within 180 days of the primary payer’s final determination; corrected claims within 365 calendar days of the notification of payment. It pays a Medicaid clean claim within 30 days, or a longer timeframe allowed by law or the provider agreement. To dispute a payment, an optional reconsideration must be requested within 120 calendar days of the notice of action (resolved within 30 calendar days), and a provider appeal filed in writing within 60 calendar days of the notice of action or reconsideration decision, each with three days added for mailing. Kansas electronic visit verification (AuthentiCare) is scoped to HCBS personal care and home health services; Sunflower’s manual does not apply it to ABA (CCTS/IIS).[9]
Sunflower's 2026 provider manual says field 17 (name of referring physician or other source) is "Required for home health, therapy, pharmacy, laboratory, DME, hospice and radiology services." It sets a priority order where several clinicians are involved: referring, then ordering, then supervising provider, each with its qualifier (DN for referring). ABA is not named on that list.[9]
Sunflower's own ABA packet already asks for a "doctor recommendation of services/prescription/order to treat." If you report that clinician in box 17, the manual warns that claims "missing or denied for Attending, Ordering, Referring or Prescribing Provider may not be corrected using Sunflower Health Plan's secure provider portal." They need an electronic or paper corrected claim.[9]
Centene’s CP.BH.104, which Sunflower lists for Medicaid behavioral health, has a coding table of CPT 97151–97158, 0362T and 0373T, followed by HCPCS H0031, H0032, H0046, H2012, H2014, H2019, S5110 and S5111. It states that the codes are “for informational purposes only,” that “Inclusion or exclusion of any codes does not guarantee coverage,” and that providers should check “applicable state guidance” before billing. Sunflower’s documentation policy CP.BH.105 pairs H0032 with 97155 for protocol modification. The Kansas guidance it defers to, KMAP Bulletins 18259 and 24125, names only CPT codes for CCTS and IIS. Ask Sunflower before billing an H-code in place of a CPT code.[7][11][17][14]
CP.BH.104’s continuation criteria require an updated behavior assessment and an updated treatment plan “at least every six months” (or as state rules define), attendance documentation (below 80% of authorized hours needs justification), performance-based caregiver training with two to four caregiver goals, and coordination of care. Progress since the last authorization must include “Updated data collected during previous treatment authorization, corresponding to all treatment settings,” behavior-reduction progress “noted in a clear and legible graphic display, including clear labels on each axis with indicators of treatment changes and environmental variables,” baseline data and frequency or duration of behaviors, and baseline plus updated progress data for each skill-acquisition goal. If progress is limited, the updated assessment must identify why and the plan must show what changed. CP.BH.105 adds that the record should show progress toward goals, including “cumulative graphs of goals and objectives and baseline data, as applicable.”[7][11]
The questions that decide whether a family can start with Sunflower Health Plan (KS), and what they have to bring. Each maps onto something intake should ask on the first call.
KS.CP.01 sets no age criterion of its own — the bound comes from the benefit it administers. CCTS and IIS are State Plan services "under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions," and KMAP Bulletin 26140 fixes the diagnostician rule for "individuals aged 20 years and younger." The policy does require the treatment plan to consider "the member's age, school attendance requirements, and other daily activities" when setting hours.[1][4][3]
Sunflower's own rule is six months: "Psychological evaluation – MD or licensed psychologist has evaluated w/in last 6 months for current validation of Autism diagnosis." Read it against the posted policy's vintage and against the newer state rule: the KS.CP.01 version on the plan's site was last reviewed 06/2019, while KMAP Bulletin 26140 (reissued 8/31/2026, effective 11/1/2026) states that a member diagnosed by a qualified diagnostician is eligible for ABA "without the need for a re-evaluation... [and] no time limit on how soon they begin autism treatment." The policy itself concedes the hierarchy: "for Medicaid members, when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence." A third document now sits beside both: Sunflower's clinical-policy index (checked 9/27/2026) no longer lists KS.CP.01 and instead lists Centene's CP.BH.104 (revised 02/26) under Medicaid Behavioral Health Clinical Policies. CP.BH.104 accepts a comprehensive diagnostic evaluation "conducted in the past three years" for treatment initiation (or a diagnostic interview within 12 months if the evaluation is three to five years old), subject to "state-defined ABA criteria" for Medicaid plans.[1][3][19][7][8]
KS.CP.01 requires the diagnosis to have been validated by an MD or a licensed psychologist. Since KMAP Bulletin 26140, for members age 20 and younger the ASD diagnosis must come from a Kansas Behavioral Sciences Regulatory Board (BSRB) licensed clinical psychologist or a qualified physician, with a multidisciplinary approach preferred. The bulletin lists the qualifying provider type/specialty codes: 11/112 Psychologist, 31/316 Family Practitioner, 31/318 General Practitioner, 31/326 Neurologist, 31/339 Psychiatrist, 31/345 General Pediatrician (Developmental), 31/349 Exempt License Physician and 31/351 Indian Health Services (the KMAP-hosted PDF of the updated bulletin omits 31/349, which Sunflower's repost and Optum's criteria both list — confirm an exempt-license physician with the MCO). A qualifying BSRB clinical psychologist needs a doctoral degree in psychology or equivalent training plus two years of supervised experience delivering BSRB-approved psychological services; qualifying physicians — developmental/behavioral pediatricians, psychiatrists, neurologists and primary care physicians — need documented additional training in ASD diagnosis, which Optum notes "may be subject to periodic Optum audit/inquiry."[1][3]
Sunflower wants two assessments in the packet, each from a named list: a criterion-referenced standardized assessment — "Vineland-III, ADOS, CARS, ADI-R, GARS, ASDS" — and a skills-based assessment — "VB-MAPP, ABLLS, AFLS, ASRS." Continuation reviews at six months need an updated skills-based assessment; the annual review needs the full standardized-plus-skills battery. The diagnostic evaluation must document DSM criteria and symptom severity level and must rest on "a validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)." Screening tools — M-CHAT, ABC, ASSQ, RITA-T, STAT — "have clinical value in recognizing children at risk of having ASD, but the diagnosis of ASD must rest on validated diagnostic tools such as those listed above." Recommended additions: a cognitive evaluation using CAT/CLAMS, MSEL or Bayley (a school district's validated cognitive testing may be used), and an adaptive measure such as ABAS or Vineland.[1][3]
The current PA form wants, for the initial 97151 request, a "referral from provider for ABA services that is within one calendar year" and a "KAN Be Healthy recommendation within one year," adding: "A general well-child visit does not meet this. It must also include a developmental screen." Continued services need an "Annual KAN Be Healthy recommendation," and the rendering provider signs the form. CP.BH.104 asks for a recommendation for ABA from a licensed physician, psychologist or other qualified professional, which "may be included within the CDE." The legacy KS.CP.01 listed the same three pieces (doctor recommendation, a signed Autism Authorization Request Form, and a Kan Be Healthy assessment by a physician, APRN, PA or credentialed RN). Missing the screen is the quiet reason authorizations stall.[10][7][1]
Sunflower defers to the state, and the state allows the core codes. CP.BH.104 says ABA may be delivered "in-person, telehealth" and tells providers to "refer to respective state allowances for telehealth services." KMAP General Bulletin 21234 lists 97151, 97152, 97153, 97155 and 97156 among the codes allowed with POS 10 (telehealth in the home) from 1/1/2022, alongside POS 02 for other locations; 97154, 97157 and 97158 are not on it. K.S.A. 40-2,213 bars the Kansas Medicaid program from excluding a covered service solely because it is delivered by telemedicine. Sunflower's documentation policy CP.BH.105 adds two telehealth rules: notes for telehealth sessions must show a HIPAA-compliant platform with the rendering provider's camera on and working audio, and the at-least-monthly one-on-one protocol-modification session (97155/H0032) must be rendered by the ABA supervisor and "Not delivered via telemedicine/telehealth unless allowed by state guidelines."[7][11][12][13]
Sunflower's 2026 manual: "For standard service authorizations, the decision and notification will be made within 7 calendar days from receipt of the request," extendable "by up to 14 additional calendar days" if the member or provider asks or Sunflower justifies needing more information. Urgent/expedited requests are decided "within 72 hours of the receipt of the request." They must come with a physician attestation of urgency and may be downgraded to routine. The clock runs from receipt, but missing clinicals "can result in a denial." The Autism Prior Authorization Request Form returns incomplete forms and says "Information older than 30 days will be considered outdated and will not be accepted for review." Timing guidance: request "at least five days prior to the scheduled service delivery date (keeping in mind a possible 7-day turnaround time)." Reauth is at least every 6 months, with an annual KAN Be Healthy recommendation.[9][10][20]
"Sunflower is always the payer of last resort." Bill the other insurer first, then send Sunflower the balance with the primary EOB on paper, or line-level COB data on electronic claims. Tertiary claims go on paper with both EOBs. Pay-and-chase is limited to "preventive and prenatal services," so ABA is not included. When the primary pays, no Sunflower authorization is needed to coordinate. Sunflower will NOT pay the balance if the primary denied for "no authorization or lack of medical necessity, untimely filing and duplicate denial," so follow the commercial plan's PA rules. The practical rule: "If the primary insurer denies for non-administrative reasons, the provider would be required to obtain an authorization for any service Sunflower Health Plan would require an authorization for if we were the primary payer," and Sunflower encourages getting it up front for "Noncovered Service" and "Benefits Exhausted" denials. For ABA against a commercial plan with a cap or exclusion, get the Sunflower PA in parallel.[9][21]
Coverage decides whether Sunflower Health Plan (KS) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
CP.BH.104 sets the floor as protocol modification: "Adaptive Behavior Treatment with Protocol Modification occurs for at least two hours per week or 10% of the direct service hours provided (whichever is greater), and no more than 20% of direct service hours provided (unless clinical documentation justifies)," and treatment must be "delivered or supervised by an ABA-credentialed professional." CP.BH.105 makes it a billing rule: 97153/97154 units not supported by that protocol-modification level are "subject to denial of payment or recoupment," and at least monthly the ABA supervisor must deliver a one-on-one session with the member to develop new or modified protocols. On the PA form the rendering provider attests "that all individuals rendering service under the proposed treatment plan have the appropriate training and education required to render services." The technician credential itself is the state's: IIS technicians qualify as RBTs under a BCBA, or through the state's KDADS-letter route. Neither CP.BH.104 nor CP.BH.105 caps how many technicians one supervisor may oversee.[7][11][10][5]
CP.BH.104 sets a soft ceiling: treatment hours "Do not exceed six hours per day up to a total of 30 hours per week" unless clinical documentation justifies more (persistent or escalating severe behaviors, interfering stereotypy, limited functional communication), with signatures from the parent and the direct-care BCBA on the revised plan. It also expects "less than 20 hours per week if attending school full-time." The state soft limits sit underneath: no more than 50 hours/year of CCTS and 25 hours/week of IIS without additional documentation. CP.BH.105 adds that billed units not fully supported by documentation may be denied or recouped.[7][11][2]
CP.BH.105 (revised 02/26), on Sunflower's Medicaid policy index, sets the rule: "Service activity notes for all services rendered are completed prior to claim submission," and each note carries the "Signature of qualified rendering provider/technician," the exact start and end time, pauses, location, and the service code. Documentation is "reviewed and updated at regular intervals" with signatures and printed names of the member, legal guardian, rendering clinician/technician and supervising practitioner as applicable. Addenda need the "Legible name, signature, and credentials of rendering clinician/technician"; a caregiver signature is recommended on notes documenting caregiver participation; and a discharge summary needs signatures of the rendering provider and the caregiver. Treatment plans under CP.BH.104 carry the signature, credentials and role of the responsible BCBA and the parent or guardian.[11][7]
No place-of-service code list is published, but CP.BH.104 sets the school rule. ABA is "not medically necessary" for "Services that are otherwise covered under the Individuals with Disabilities Education Act (IDEA)," with the note: "Unless restricted within a state Medicaid benefit, ABA services can occur in coordination with school services and transition plans." Where it applies, the treatment plan must carry "Detailed school-based plan requirements" — hours, target behaviors, a titration plan showing "when school services can be reduced or stopped," and school-specific graphs — and services that are "in lieu of school" are a ground for discontinuation. Every note must record the location (CP.BH.105). No KMAP rule on school-based CCTS/IIS could be retrieved, so confirm a school location with Sunflower UM at authorization.[7][11]
Not addressed in KS.CP.01, and not published at state level either.[1]
Ask the plan: Sunflower provider services and Centene's payment policies on sunflowerhealthplan.com; submissions run through the standard secure portal / Availity PA channels.
Not addressed in KS.CP.01. The binding rule is the state's: every group and every individual — each BCBA and each RBT — must hold their own KMAP ID before an MCO can pay, with a separate enrollment for each service location, and new hires must be KMAP-enrolled before anything can be billed under their NPI. Sunflower's 2026 provider manual adds the plan step without an ABA-specific carve-out: "All providers wishing to participate in the Sunflower KanCare network must enroll through KMAP first," KMAP then sends the enrollment to the chosen MCOs "for credentialing and contracting," and "KMAP approval does NOT guarantee participation in the Sunflower network. You must be contracted and credentialed by Sunflower before providing services to Sunflower members." The manual does not say whether each RBT/IIS technician is credentialed individually or carried on the group's roster.[1][6][9]
Ask the plan: Sunflower provider services (1-877-644-4623) or your Sunflower Provider Engagement account manager: ask whether each IIS technician must be individually credentialed and loaded before billing under their own NPI, or only KMAP-enrolled under the group. KMAP enrollment governs who may appear on the claim.
Yes — as KanCare's CCTS/IIS autism-services benefit under EPSDT, with prior authorization via the Autism Authorization Request Form, a physician recommendation, and named standardized plus skills-based assessments.
Sunflower requires Medicaid members to have a current Kan Be Healthy (EPSDT) screen completed within the past year by a physician, APRN, PA, or credentialed RN — explicitly not the same as a well-child exam. Missing it silently stalls the authorization.
Sunflower's documents conflict. Its KS.CP.01 policy (last reviewed 06/2019) says validated within the last 6 months by an MD or licensed psychologist. KMAP Bulletin 26140 (eff. 11/1/2026) says a member diagnosed by a qualified diagnostician — a Kansas BSRB-licensed clinical psychologist or qualified physician using a validated tool — needs no re-evaluation and faces no time limit, and KS.CP.01 itself says state Medicaid rules take precedence. Sunflower's policy index now lists Centene's CP.BH.104 (evaluation within three years) instead of KS.CP.01. Ask Sunflower UM which rule it applies before sending a family for a re-evaluation.
Hours are individualized. CP.BH.104, the policy now on Sunflower's index, needs extra clinical justification above six hours a day or 30 hours a week, and expects under 20 hours a week for a child in school full-time. The state soft limits — 50 hours/year of CCTS and 25 hours/week of IIS — can be exceeded with additional documentation. The focused/comprehensive tiers came from the older KS.CP.01.
Yes. Sunflower's Autism (Non-Waiver) PA form lists 97151 and 97152. For the initial assessment send comprehensive diagnostic information with standardized measures, an ABA referral dated within one calendar year, and a KAN Be Healthy recommendation within one year that includes a developmental screen.
Yes for the codes KMAP allows: 97151, 97152, 97153, 97155 and 97156 with POS 10 (home) or 02 (elsewhere), per KMAP Bulletin 21234; Sunflower's CP.BH.104 defers to state allowances. Keep the monthly one-on-one protocol-modification session in person unless state guidance allows it remotely (CP.BH.105), and document the platform and camera use on telehealth notes.
Sunflower adds no credential of its own. The KanCare rule applies: IIS technicians qualify as RBTs under a BCBA or through the state's KDADS-letter route, and each must be KMAP-enrolled. The rendering provider attests on the PA form that everyone on the plan has the required training, and CP.BH.104 requires treatment delivered or supervised by an ABA-credentialed professional. Whether Sunflower credentials each technician individually is not published; ask its network team.
Sunflower publishes no transfer rule. Authorizations are requested per provider, and a new agency that skips the initial assessment request must send all the assessment items with its first treatment plan. Ask Sunflower UM (1-877-644-4623) before the new agency submits whether it needs the old agency's discharge date.
No public ABA rate table. Sunflower's sample Medicaid agreement pays the lesser of billed charges or its Medicaid fee schedule and offers a sample of fees on written request. The state benchmark for 97153 is $16.25 per 15 minutes (KMAP Bulletin 24125).
Sunflower publishes no ABA moratorium. Enroll with KMAP first and pick Sunflower; KMAP sends the file for credentialing and contracting, which Sunflower aims to finish within 30–45 days of a complete application. Ask Contracting (1-877-644-4623) about need in your area.
Kansas requires a Kansas license to practice ABA “in this state” (K.S.A. 65-7503). Confirm KMAP enrollment before treating KanCare members from another state.
Only for extenuating circumstances (such as a member who did not have the Sunflower card, or another payer later finding the member ineligible) or retroactive eligibility; decision within 30 days, no later than 180 days from the date of service.
180 calendar days from the date of service for a first-time claim, and 365 days from the notification of payment for a corrected claim (Sunflower provider manual, February 2026).
Not by name. Its manual requires field 17 for home health, therapy, pharmacy, laboratory, DME, hospice and radiology, and ABA is not on that list. A missing or denied referring-provider field cannot be fixed in the portal, so send a corrected claim.
Centene’s CP.BH.104 lists H0031, H0032, H2014 and H2019 alongside the ABA CPT codes but calls the list informational and defers to state guidance, and KMAP’s autism bulletins name only CPT codes. Confirm with Sunflower before billing an H-code.
Yes for behavior reduction: CP.BH.104 requires a clear, labeled graphic display with baseline and treatment-change markers, plus baseline and updated data for every skill goal, an updated assessment and plan at least every six months, and data from all treatment settings.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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