Providers
The first thing physicians discover about Great Plains Medicare Advantage is that we aren’t just another Medicare Advantage plan.
We believe in providing proactive care, creating personalized experiences and offering exceptional benefits to our members and providers. This approach allows us to make a difference in the lives of our members – and your patients.
In addition, we’re committed to simplifying health insurance administration so our providers can focus on delivering high-quality patient care. As questions arise, our team is here to collaborate with you and assist with coordinating next steps so we can best meet the needs of those we serve.
Provider Portal
For all claims with service dates before or in 2025, visit our Medicare Advantage provider portal.
On Jan. 1, 2026, Great Plains Medicare Advantage rolled out a new provider portal to streamline processes and improve your overall experience. You can request access to the new provider portal for claims starting on or after Jan. 1, 2026. If you’ve already received your login information, you access the portal at any time.
Claims
Submit claims to Great Plain Medicare Advantage using Payor ID RP035. We encourage you to submit claims electronically for faster reimbursement and efficiency. We accept CMS professional 1500, UB-04 or ADA claim forms.
You can also submit professional 1500 claims through our Medicare Advantage provider portal.
Paper claims can be mailed to:
Medicare Advantage Claims
P.O. Box 8000
Marshfield, WI 54449-8000
For Prescribers & Pharmacies
Great Plains Medicare Advantage provides Medicare Part D prescription drug coverage through our partner OptumRx.
OptumRX Pharmacy Helpdesk
(844) 368-8732 (TTY: 711)
Refer to the materials below for more information.
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. Our care model addresses each member’s medical, functional and behavioral healthcare needs in a coordinated and member-centric manner.
To ensure members receive the services necessary to achieve their short- and long-term goals, our model of care leverages provider resources and places member preferences at the center of the care planning process.
Our model incorporates best practices and industry innovations, including:
- A care team that provides facility-based support and is led by an advanced nurse practitioner and primary care physician or NFist (a primary care physician who specializes in caring for skilled nursing home patients)
- A risk-assessment tool designed for a skilled nursing facility patient population
- A comprehensive history and physical assessment that generates an individualized care plan
- A care management platform that helps identify preventive health needs/HEDIS services, which ensures the use of evidence-based clinical guidelines and facilitates care team communications for care coordination
- 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
We are committed to providing model of care training and education for providers in the Great Plains Medicare Advantage network to meet the needs of our institutional Medicare beneficiary population.
We provide training to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), which requires that all special needs plans provide a general understanding of the model of care framework.
Sanford Health Plan requires all contracted organizations that provide services to Great Plains Medicare Advantage members to complete annual model of care training and then attest that the training was offered to all providers within your organization that care for Medicare Advantage members.
You can access the training presentation in this PDF.
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 healthcare 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.
Provider Materials
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- 2026 Provider Appeal Form
- Genetic Prior Authorization Form
- Medical Claim Form
- Medical Policies
- Model of Care
- Part B: List of Covered Drugs Requiring a Prior Authorization
- Part B: Prescription Drug Prior Authorization Request or Formulary Exception Form
- Part D: Prior Authorization Request Form
- Post Acute Prior Authorization Form
- Prior Authorization Form
- Prior Authorization Requirement Guide
- Provider Claim Reconsideration Request Form
- Provider Manual
- Waiver of Liability
Page last updated Aug. 20, 2026