Providers & Partners
The first thing physicians discover about Great Plains Medicare Advantage (HMO I-SNP) and Great Plains Medicare Advantage Gold (HMO I-SNP) is that we aren’t just another Medicare Advantage health plan. We have a different philosophy, attitude and approach to caring for our Members. Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our Members, your patients’, quality of life.
We believe in providing our Members exceptional benefits and an abundance of attention. And, we believe Great Plains Medicare Advantage providers deserve the same.
And we are committed to simplifying the administration of health insurance so our providers can devote their attention to providing high-quality health care.
We are always available if questions arise, and we collaborate with our providers to help ensure the efficient delivery of superior care to our members.
Provider Portal
For all claims with 2025 service dates and prior, please visit our Medicare Advantage Provider Portal using the link provided here.
Beginning Jan. 1, 2026, Great Plains Medicare Advantage will be rolling out a new Provider Portal to streamline processes and make your experience better. You can request access to the new provider portal for claims Jan. 1, 2026 and after. If you’ve already received your login information, you can access the new portal beginning Jan. 1, 2026.
Claims
Claims should be submitted to Great Plain Medicare Advantage using Payor ID RP035. We encourage you to submit claims electronically for faster reimbursement and increased efficiency. Accepted claim forms are the CMS professional 1500, UB-04, or ADA claim form.
The plan also offers the ability to submit professional 1500 claims through our MA Provider Portal.
Paper claims can be mailed to:
Medicare Advantage Claims
P.O. Box 8000
Marshfield, WI 54449-8000
For Facility Partners
We offer resources for our partner facilities to help residents understand Great Plains Medicare Advantage. Resources include screensavers, posters and social media posts. Download the resources here.
For Prescribers & Pharmacies
Great Plains Medicare Advantage provides Medicare Part D prescription drug coverage through our partner OptumRx.
OptumRX Pharmacy Helpdesk
Phone number: 1-844-368-8732
TYY Phone number: 711
Refer to the Member Resources page for formulary, prior authorization criteria, and step therapy criteria.
Institutional Special Needs Plan Model of Care & Training
The Great Plains Medicare Advantage Model of Care focuses on providing a unique level of customized clinical care and services for residents in skilled nursing facilities. As we help extend our members’ care, our care model concentrates on addressing each Member’s full range of medical, functional, and behavioral health care needs in a coordinated and Member-centric manner. This means putting the Member’s preferences at the center of the care planning process and leveraging Provider resources to ensure every Member receives the services necessary to achieve their short- and long-term care goals.
Our model organizes best practices and industry innovations including:
- The Advanced Nurse Practitioner (ANP) and primary care physician (PCP)/NFist (a PCP specializing in the care of skilled nursing home patients) care team providing onsite, facility-based PCP support;
- A risk-assessment tool designed for a senior, skilled nursing facility patient population;
- A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP);
- A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for care coordination; and
- Frequent face-to-face Member and caregiver/family member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.
It is important that all of our Providers are properly trained and informed about the Great Plains Medicare Advantage Model of Care. Our top priority is making sure all of the providers in the Great Plains Medicare Advantage network meet the training and education needs of our institutional Medicare beneficiary population. The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care.
Sanford Health Plan requires all contracted organizations that provide services to a Great Plains Medicare Advantage members to complete annual Model of Care (MOC) training and then attest that the training was offered to all providers within your organization that provide care for our Medicare Advantage members.
The training presentation can be accessed here.
Become a Great Plains Medicare Advantage Network Provider
Great Plains Medicare Advantage contracts with physicians, facilities and other allied providers to ensure we have an adequate provider network which is essential for the delivery of health care services to our members. All providers must be credentialed before they can be added to our network as a participating provider.
For more information on becoming a contracted provider, please email sanfordhealthplanprovidercontracting@sanfordhealth.org or visit our enrollment and credentialing site at sanfordhealthplan.com/providers/contracting-and-credentialing.
Provider Materials
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- Medical Policies
- Model of Care
- Provider Manual
- Provider Claim Reconsideration Request Form
- Waiver of Liability
- Medical Claim Form
- Prior Authorization Requirement Guide
- Prior Authorization Form
- 2026 Provider Appeal Form
- Post Acute Prior Authorization Form
- Genetic Prior Authorization Form
- Part B: List of Covered Drugs Requiring a Prior Authorization
- Part D: Prior Authorization Request Form
- Part B: Prescription Drug Prior Authorization Request or Formulary Exception Form
Page last updated Jan. 28, 2026