Simply click on the document below to open in Adobe and then you can review, print or save the document.
Note: Sanford Central Verification Office participates with the Minnesota Credentialing Collaborative, therefore accepts credentialing applications electronically through the site located at www.mncred.org.
Sanford Health Plan is responsible for adopting and distributing clinical practice guidelines for acute, chronic and behavioral health care services that are relevant to our membership. Clinical practice guidelines are systematically developed statements that help practitioners and members make decisions about appropriate health care for specific clinical circumstances. These guidelines can improve health care and reduce unnecessary variations in practice patterns. Practice guidelines are based on reasonable medical evidence, such as clinical literature and expert consensus. The Plan's multi-specialty physician committee, the Physician Quality Committee, has reviewed and approved practice guidelines for numerous conditions. Where links are provided, Sanford Health Plan has adopted the clinical practice guidelines exactly as they are written by the respective organizations. If you have any questions or suggestions regarding these guidelines or would like to request a copy of the guidelines, please visit the mySanfordHealthPlan provider portal or call the Health Plan at (800) 601-5086 or (605) 328-6877.
The following guidelines in this section were developed by the Sanford Clinical Practice Committee and adopted by Sanford Health Plan's Physician Quality Committee.
Appropriate Antibiotic Utilization
Breast Cancer Screening
Cervical Cancer Screening
Congestive Heart Failure
Sanford Health Plan is committed to consistent improvement. Please review our Quality Improvement program here.
This Hedis report is Sanford Health Plan's commitment to our customers that we will continue to provide cost effective, quality care and service.
The Sanford Health Plan Formulary is a list of medications that are the most effective for the treatment and diagnosis of disease and maintenance of health according to the clinical judgment of the physicians, pharmacists and other health care professionals who serve on the Physicians Quality Committee that approved the formulary.
For a complete listing of the formulary and pharmacy management procedures (including things like generic substitution, prior authorization, step therapy protocols and more). Log on to your provider account here.
What If a Prescription Drug Is Not On The Formulary?
Sanford Health Plan uses a Formulary to help members save money and help control the costs of healthcare. Of course, not all drugs are included in the formulary. However, we understand that sometimes exceptions must be made. A Medication Request Form can be used if:
If you have questions regarding our formulary, contact our Pharmacy Management Team at the numbers below: