| What Do I Need to Know About Mumps pdf (144k) 2008 Formulary Changes pdf (27k) Refusing to Treat a Sanford Health Plan Member It is your right as a provider to refuse to continue to provide services to a Sanford Health Plan member. While this is most likely a very rare event, it is required that you contact Sanford Health Plan in such an event so we can assist this member in transitioning to a similar specialist. If you find yourself in a situation where you choose to discontinue rendering services to a Sanford Health Plan patient, please contact your Provider Relations representative or contact the Provider Relations department toll free at 1-800-601-5086. Digital Health Plan Have you ever misplaced an Explanation of Payment (EOP) and needed a copy? Digital Health Plan will allow providers to verify member eligibility, member benefits, claim status and access EOP's. Note: an EOP will only be available for claims that have been completely processed. As a provider, you must have a personal account to Digital Health Plan in order to view an EOP. Please log on to Digital Health Plan. Feel free to contact the Provider Relations Department at 800-601-5086 with questions. Credentialing Sanford Health Plan is committed to be in full compliance with the standards set forth by National Committee for Quality Assurance (NCQA). NCQA requires that all contracted providers be completely credentialed before rendering services to Health Plan members. To meet this requirement, all providers must be fully Credentialed and approved by Sanford Health Plan‘s Credentialing Committee prior to becoming effective in our network as a participating provider. This includes any new providers joining the practice or group. The Provider’s effective date with Sanford Health Plan will no longer be the date contracts were signed or the date Sanford Health Plan was notified to add the provider to existing contracts; the effective date will be the date credentialing was completed. Once the Credentialing process has been completed, Providers will receive a letter notifying them of their effective date and Sanford Health Plan provider identification number for claims submission. The intent of Credentialing is to conduct timely verification of information to ensure that practitioners have the legal authority and relevant training and experience to provide quality of care. How long does the Credentialing process generally take to complete? The Credentialing process should take as little as 30 days but no more than 180 days depending on the ability of the Sanford Central Verification Office to verify the Provider’s credentialing information. What happens if a provider provides services to a Sanford Health Plan member prior to completing the Credentialing process? In the event Sanford Health Plan receives claims from a provider prior to completing Credentialing at the time services were rendered, the charges will be denied and it is the provider's responsibility to write off applicable charges. This is why it is important to send in completed Credentialing applications as soon as it is known a Provider will be starting or joining a practice. Where can I get a Credentialing application? Credentialing applications can be found on the Provider website under Credentialing Information. Thank you in advance for your cooperation with Sanford Health Plan’s Credentialing Policy. If you have any questions, please contact the Provider Relations Department at 1-800-601-5086. Provider NewslettersMedical Updates Newsletters are sent to participating providers when the Medical Director of Sanford Health Plan wants to relay important information directly to providers. The Provider Perspective goes to participating providers on a quarterly basis and contain important provider reminders and information pertinent to being a Sanford Health Plan provider.Medical Updates Newsletters January 2007 Medical Updates Provider Perspective Winter 2008 4th Quarter 2007 3rd Quarter 2007 2nd Quarter 2007 |
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