sanford health plan policy updates
Track new and updated sanford health plan policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Step Therapy Criteria for Select Pharmacy & Specialty Drugs | Sanford Health Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| Stelara biosimilars formulary placement and related provider guidance | Sanford Health Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Apr 1, 2025 |
| Claim Edits (Optum CES automated claim editing and mappings) | Sanford Health Plan | Reimbursement | — | Modified | Jul 15, 2020 |
| HIPAA Transaction Standard Companion Guide (270/271) | Sanford Health Plan | Administrative | — | Modified | Feb 1, 2015 |
| HIPAA Transaction Standard Companion Guide (276/277) | Sanford Health Plan | Administrative | — | Modified | — |
| Institutional Provider Credentialing | Sanford Health Plan | Administrative | — | Modified | — |
| Practitioner Credentialing Program | Sanford Health Plan | Administrative | — | Modified | — |
| Transition Policy 2025 Medicare | Sanford Health Plan | Administrative | — | Modified | — |
| Synagis (palivizumab) prior authorization form coverage criteria | Sanford Health Plan | Clinical | Pharmacy & Specialty Drugs | Modified | — |
| SSRIs and SNRIs for depression — patient and clinician information | Sanford Health Plan | Clinical | Psychiatry/Behavioral Health | Modified | — |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.