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.
Claims
Claims with dates of Service 2022 and forward 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:
Great Plains Medicare Advantage
P.O. Box 981813
El Paso, TX 79998-1813
For Partners
For Prescribers & Pharmacies
Great Plains Medicare Advantage provides Medicare Part D prescription drug coverage through our partner OptumRx.
Access information, forms, claims detail, prior authorizations at https:/professionals.optumrx.com/.
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 & attestation can be accessed through the provider portal at ehealth-shp.healthsuiteadvantage.com.
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 https://www.sanfordhealthplan.com/providers/contracting-and-credentialing.