Sanford Health Plan regularly updates, modifies and enhances its claim system to ensure appropriate and accurate payments.
 
We will be implementing an additional claim editing system to ensure we follow current published reimbursement policies and validate correct coding guidelines as documented in CPT, HCPCS Level II, ICD-9 and ICD-10 as well as generally accepted billing guidelines. This will help provide greater focus on identifying incorrect, inappropriate or duplicative services and/or payments.
 
A list of edits will be provided prior to implementation, including a description and remark codes. We communicated on September 1, an enhancement to our claim editing protocols to take effect on 11/1. In transparency, we are notifying you of a delay in our implementation of that enhancement initiative, now scheduled for implementation on 1/15/2026. Please check back for more details ahead of that implementation.