Availability of UM and CMO
The objective of our Utilization Management program is to ensure that medical services provided to members are medically necessary and/or appropriate, as well as in compliance with the benefits of the plan.
There are three (3) ways to request prior authorizations for health care services through the Utilization Management department.
- Online: Select “Submit/Request/Report” under “Provider Inquiries” in your secure mySanfordHealthPlan account.
- Phone: (800) 805-7938
- Fax: Please fax the prior authorization form and supporting documentation to (605) 328-6813
All requests for certification must be made by the member or the practitioner's office at least three (3) business days prior to the scheduled admission or requested service. In the event that health care services need to be provided, within less than three (3) business days, the Utilization Management department should be contacted to request an expedited review. The member is ultimately responsible for obtaining prior authorization. However, information provided by the practitioner's and/or provider's office also satisfies this requirement.
If you have a question for our Utilization Management team, they are available to help you between 8 a.m. and 5 p.m. CT, Monday through Friday, by calling (800) 805-7938. After business hours, you may leave a confidential voicemail and you will receive a call the next business day.
If you have a question regarding the criteria used in making decisions, you may contact our Vice President, Medical Officer between 8 a.m. and 5 p.m. Monday through Friday CT, at (800) 805-7938.