Provider EDI Resources

Providers, both institutional and professional, may use practice management system vendors, billing services or clearinghouses to submit claims and other EDI transactions to Sanford Health Plan.

These vendors offer a variety of EDI solutions to the health care community and charge fees or transaction costs for their services. Sanford Health Plan does not specifically recommend or endorse any vendor or billing service.

Trading Partner Electronic Transaction Exchange Enrollment

Sanford Health Plan exchanges data with several vendors and clearinghouses. In order to exchange data electronically with Sanford Health Plan, trading partners must complete our trading partner agreement.

To discuss direct claim submittal or technical transaction questions contact the EDI department

Transitioning to ICD-10

Sanford Health Plan met the ICD-10 mandate that was effective on October 1, 2015. For more information on the ICD-10 transition, please read the attached memo and FAQ.

837 Transactions

Sanford Health Plan encourages the use of EDI transactions to increase efficiency and reduce errors. Sanford Health Plan will accept ANSI 837 version 5010 compliant claim transactions meeting our companion guide criteria.

Claims may be sent electronically through the following clearinghouses with Payor ID 91184.

Please note: Other practice management system vendors, billing services and clearinghouses may be available to Providers to submit 837 transactions and charge fees or transaction costs for their services. Sanford Health Plan does not specifically recommend or endorse any vendor or billing service.

Other important websites:

Electronic Funds Transfer (EFT)

By enrolling to receive EFTs, Provider experience quicker receipt of payments. To enroll and begin receiving EFT payments from Sanford Health Plan, complete the Sanford Health Plan EFT Enrollment Form

For more information about receiving EFT transactions directly from Sanford Health Plan, contact our EDI department.

Sanford Health Plan also partners with Change Healthcare to deliver ePayment services, consisting of electronic funds transfer (EFT) and electronic remittance advice (ERA) transactions in the postable 835 format. Change Healthcare provides payer remittance data electronically via Change Healthcare Payment Manager, which is offered as a complimentary service with EFT enrollment. You will continue to receive paper remittances for 45 days after EFT enrollment. After the 45 days has expired, paper remittances will no longer be sent. However, these documents will continue to be available electronically through Payment Manager. With Payment Manager, staff can search, view or print each remittance as needed. For enrollment to Change Healthcare ePayment, simply follow the instructions outlined in the following link to begin receiving electronic payments and remittance advices.

835 Transactions

Sanford Health Plan has partnerships with the following clearinghouses to send 835 transactions. If you would like to receive the 835 transaction directly from Sanford Health Plan, fill out the form below and contact our EDI department.

270/271 Transactions (Real Time Transactions)

For more information about 270/271 transactions please contact our EDI department.

276/277 Transactions (Real Time Transactions)

For more information about 276/277 transactions please contact our EDI department.