Sanford Health Plan reimburses commercial services at Skilled Nursing Facilities (SNF) in North Dakota at 100% of the state's equalization rate.

The total billed amount on the claim must equal the reimbursement amount providers are due based on the state equalization rate in effect for the dates of service reported on the claim, as these rates may change annually.

Providers are responsible for submitting the HIPPS code that accurately reflects the level of care rendered for each date or span of service. Since a member’s level of care may change during the course of a SNF stay, claims must accurately reflect the correct HIPPS code and corresponding level of care for each billed period.

Sanford Health Plan reserves the right to conduct periodic billing audits to verify the correct use of state equalization rates, HIPPS codes and billed levels of care. The health plan may recover any overpayments identified through these reviews.