Forms

Flu Shot Roster
pdf (176k)
Medical Request Form
pdf (696k)
Provider Change Form
pdf (50k)
Claim Reconsideration
pdf (43k)

All Providers (both participating and non-participating) submitting claims to Sanford Health Plan must complete a W-9 Form. You may fax this form to Sanford Health Plan Provider Relations Department at 605-328-7224.

W-9 Form
pdf (72k)