Provider Enrollment & Credentialing
Sanford Health Plan has updated the provider enrollment and credentialing process for individual practitioners and facilities. Once a Provider Contract has been executed with Sanford Health Plan, we will begin our provider enrollment and credentialing process following NCQA standard guidelines.
Step 1: Request a New Provider Contract
A Provider Contracts Specialist will contact you when the New Provider Contract Request Form has been submitted and reviewed. A participation agreement and provider payment methodology will be sent to the contact person listed on the form. Existing Sanford Health Plan Providers with contracts go to Step 3.
For any additional questions on the New Provider Contract, please contact Provider Contracting at:
Toll-free: (855) 263-3544
Email: sanfordhealthplanprovidercontracting@sanfordhealth.org
Step 2: Provider Enrollment and Credentialing
Please wait to complete Step 2, both Part A and Part B, after you have received an executed contract.Part A: Provider Enrollment Application
The provider enrollment form must be completed for any newly contracted providers.
For any additional questions on the Provider Enrollment Form, please contact Provider Relations at:
Phone: (800) 601-5086
Email: providerrelations@sanfordhealth.org
Part B: Initial Credentialing Application Request form
This form will begin the process for the credentialing application process. After submitting, a Sanford Health Plan representative will reach out to utilize the Sanford Provider Hub for the next steps of the 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.
For any additional questions on the Initial Credentialing Application Request Form, please contact us at:
Phone: (605) 312-7600
Email: VerificationServices@Sanfordhealth.org
Step 3: Provider Information Update/Change
Fill out the Provider section of this form if you have a provider update. Examples include: adding/removing a provider, demographic changes
Fill out the facility section if you have a facility update. Example include: Facility name changes, tax id changes, phone number or address updates.
We request a 60-day notice to be able to communicate these changes to our members.
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
Facility Credentialing Application
The facility credentialing application must be completed for any newly contracted facility or when adding a facility to your current contract. Once completed, email to sanfordhealthplanprovidercontracting@sanfordhealth.org for processing. An on-site survey may be deemed necessary to approve an application.
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.