Clinical & Other Resources

Claims

• Check your claim status here
• Claim Reconsideration Form is now located within the Provider Portal.
  • Request Provider Portal Access (External use only. Sanford Health users submit an ESAR) 
  • Provider Portal Navigation guide (pages 7-9)
• Flu & COVID-19 Vaccine Roster

Credentialing Applications

Detailed Facility and Practitioner Credentialing forms and Sanford Provider HUB information can be found here.

Medical Management Forms

• Benefit Coverage Consideration Request Form
• Diabetes Eye Exam Consult Form
• Health Management Program Referral Form
• Medical Prior Authorization Request form
• ND Medicaid Expansion CSP Referral Form
• Prescription Drug Prior Authorization Request & Formulary Exception Form
• Synagis - Drug Prior Authorization Request and Formulary Exception Form

Provider Demographic & Other Forms

• Member Authorization for Access to health Information (HIPAA) Form
• Provider Update/Change Form
• Third Party Release Privacy Authorization
• W-9 Form
• IDR Open Negotiation Period Request Form

Documents

• Prior Authorization List
• Claim Edit List
• Sanford Health Plan ID cards
• Understanding Your Check Adjustment Report

Manuals

• Provider Manual
• Provider Manual (PDF)
• Provider Onboarding Manual

Medicare Advantage

For more detailed information and forms, log into the MA Provider Portal.

• Medicare Advantage Provider Portal 
• Provider FAQs on Medicare Advantage (pdf)
• Align powered by Sanford Health Plan Forms
  • Medical Prior Authorization Form
  • Provider Claim Reconsideration Form
  • Waiver of Liability
• Great Plains Medicare Advantage (I-SNP) Provider & Partners