Sanford Health Plan transitioned, effective Jan. 1, 2026, to a new vendor platform for claims and administrative service for Medicare Advantage (MA) lines of business, including Align powered by Sanford Health Plan (MA, MAPD), Align DUALPartnership (D-SNP) and Great Plains Medicare Advantage (GPMA, I-SNP). 

We've updated the FAQ; here are a few key things to note:

How do I submit a prior authorization request for service dates after Jan. 1, 2026? 
Prior authorizations can be submitted through the new Sanford Health Plan provider portal or faxed to (715) 221-6616.

How do I check member eligibility and benefits? 
To check eligibility through the portal for dates of service prior to Jan. 1, 2026, continue to use https://ehealth-shp.healthsuiteadvantage.com/.

For dates of service on or after Jan.1, 2026, please refer to the new Sanford Health Plan provider portal. 

Is the claims submission process changing? 

The electronic claims process is not changing. Providers should continue submitting electronic claims as usual, using the existing payor ID (RP035). Availity will route claims to the appropriate platform based on date of service. 

Electronic claims submission is preferred; however, all paper claims, regardless of date of service, submitted after Jan. 1, 2026, should be mailed to the following address: 

Sanford Health Plan
Attn: Claims 
P.O. Box 8000
Marshfield, WI 54449-8000

Claims can also be faxed to (715) 221-9650.

Are new EFT/ERA forms needed to receive payments? 
No. Electronic remittances and electronic fund payments will continue to be available through Zelis. 
Claims with date of service in 2025 or earlier: Payment and provider remit files will continue to flow through Zelis as they do now for both paper and electric claims.

Claims with dates of service in 2026: Providers who have historically received e-payments from Zelis for Align powered by Sanford Health, Align DSNP or Great Plains Medicare Advantage may need to enroll in e-payments under Security Health Plan’s Zelis Payer ID 248 to continue receiving e-payments for these plans moving forward. 

Providers can enroll in Zelis electronic payments two ways: 
1. Zelis payer ID 248 payment center.
2. Call ZPN provider services at (877) 828-8770. Please indicate Security Health Plan, Zelis Payer ID 248. 

Organizations that don’t enroll in e-payments under Payer ID 248 may begin to receive paper checks for claim payments.