Sanford Health Plan is updating its subrogation process in mid-June. This update is intended to improve how claims involving potential third-party liability (TPL) payers are handled. While the same guidelines will continue to apply, the order in which the process is implemented will change.

When a claim is identified as potentially involving a TPL payer, it will enter a pending status while we contact the member to obtain additional information. If the member does not respond to our inquiry within 30 days, the claim will be denied to the member. Providers may bill the member for the charges as member responsibility.

As a provider, you will no longer receive recoupments due to members not completing their accident or injury investigation review. This will now be completed prepayment, avoiding repeated claim recoupments.