Simply click on the document below to open in Adobe and then you can review, print or save the document.
- Claim Reconsideration Form
- Claim Reconsideration Online Form - requires login to secure provider account
- Flu Shot Roster
Provider Demographic Forms
Medical Management Forms
- Benefit Coverage Consideration Request Form
- Diabetes Eye Exam Consult Form
- Formulary & Prescription Drug Prior Auth Request Exception Form
- Health Management Program Referral Form
- Medical Prior Authorization Request form
- ND Medicaid Expansion Transition of Care Request Form
- Sanford Health Heart of America Health Plan Referral Request Form
Facility and Provider Credentialing Applications
Note: Sanford Central Verification Office participates with the Minnesota Credentialing Collaborative, therefore accepts credentialing applications electronically through the site located at www.mncred.org.