Provider Contracting & Credentialing

Step 1: Complete our Contract Request Form

A Provider Contracts Specialist will contact you once the Contract Request Form has been reviewed. We respond to all contract requests, but we do not guarantee that a contract offer will be extended. If a contract is extended, you will be asked to proceed to the steps outlined in Step 2 below.

Step 2: Provider Enrollment and Credentialing

If we determine that you meet our contracting eligibility criteria, you will receive a contract offer and be invited to begin our credentialing and enrollment processes. These steps must be completed for any newly contracted providers.

Provider Enrollment Application – All newly contracted providers will need to complete our Provider Enrollment Application.

Individual Provider Credentialing Request Form – Required for all individual providers who will be billing professional claims on the CMS-1500 form. Please complete this form even if the provider is already credentialed with Sanford Health Plan, as it ensures our Credentialing team will receive updated practice information.

Facility Credentialing Application – Required for all facility-based providers who will be billing facility claims on either the CMS-1500 or UB-04 form.

Please note only individual providers and facilities are required to complete credentialing. We do not credential professional groups at the group level.

For additional questions on our initial contracting process, please contact Provider Contracting at:

• Phone: (855) 263-3544
• Email: sanfordhealthplanprovidercontracting@sanfordhealth.org

In order to add a new provider or facility to your existing contract, you will need to complete credentialing for that provider or facility, and then complete our Provider Information Update/Change Form.

Individual Provider Credentialing Request Form – Required for all individual providers who will be billing professional claims on the CMS-1500 form. Please complete this form even if the provider is already credentialed with Sanford Health Plan, as it ensures our Credentialing team will receive updated practice information.

Facility Credentialing Application – Required for all facility-based providers who will be billing facility claims on either the CMS-1500 or UB-04 form.

Provider Information Update/Change Form – Required for all practice updates to an existing provider contract. Some examples include:

• Adding or removing a provider
• Updating provider demographic information
• Facility or group name changes
• Facility or group address changes
• Tax ID changes

For additional questions on adding a new provider or facility to your existing contract, please contact Provider Relations at:

• Phone: (800) 601-5086
• Email: providerrelations@sanfordhealth.org

Please complete our Provider Information Update/Change Form. This form is required for all practice updates to an existing provider contract. Some examples include: Adding or removing a provider, Updating provider demographic information, Facility or Group name changes, Facility or Group address changes, or Tax ID Changes.

NOTE: We request 60 days’ notice to be able to communicate these changes to our members.

For additional questions on updating provider, group, or facility information, please contact Provider Relations at:

• Phone: (800) 601-5086
• Email: providerrelations@sanfordhealth.org

Please contact Provider Contracting at:

• Phone: (855) 263-3544
• Email: sanfordhealthplanprovidercontracting@sanfordhealth.org

For Individual Providers: All newly contracted providers must complete our Initial Credentialing Application Request Form. Sanford Health Plan utilizes the Sanford Provider Hub for the Individual Provider credentialing process.

Sanford Provider Hub offers a secure solution for all credentialing activities through Sanford Health Plan with a user-friendly interface and automation to streamline the credentialing process and significantly reduce paperwork.

• Sanford Provider Hub FAQ

For Facilities: Please complete our Facility Credentialing Application for any newly contracted facility, or when adding a facility to your existing contract.

Once completed, email the application and all supporting documentation to: sanfordhealthplanprovidercontracting@sanfordhealth.org for processing. An on-site survey may be deemed necessary to approve an application.

Recredentialing:

All Sanford Health Plan participating practitioners and facilities must be recredentialed at least every 36 months. At the time of your recredentialing, Verification Services will send an email providing you the next steps for use of the Provider Hub. Add VerificationServices@SanfordHealth.org to your safe sender list to ensure you receive this email.

For any additional questions regarding credentialing, please contact our Credentialing Department at:

• Phone: (605) 312-7600
• Email: VerificationServices@Sanfordhealth.org

Credentialing Policies:

Sanford Health Plan maintains policies for our credentialing and recredentialing process. For access to our policies, simply click on the appropriate link below.

• Practitioner Credentialing Policy {PR-006}
• Organizational Provider Credentialing {PR-020}