Providers & Partners
Are you a NEW provider and need to submit a claim?
Requirements for Submitting Your First Claim
The PrimeWest Health provider network is made up of more than 6,000 health and social services practitioners and facilities in Minnesota and the surrounding states. Our network covers the entire health and social services provider continuum, giving PrimeWest Health members optimum access to and choice of providers.
PrimeWest Health network providers, also referred to as "participating providers," have contracted with us to deliver quality and cost-effective care to over 23,000 PrimeWest Health members who live in our 13 counties and are eligible for Minnesota Health Care Programs (MHCP). (Visit About Us for more information about MHCPs administered by PrimeWest Health.)
- Higher reimbursement rates for some entities
- Priority or preferential claims processing/payment turnaround
- Preferential consideration of provider Appeals related to claim submission timeliness
- Fewer Service Authorization (prior authorization) requirements
- Eligibility for pay-for-performance compensation above their PrimeWest Health standard reimbursement rate
- Eligibility for PrimeWest Health's Community Reinvestment in Health Care grants
PrimeWest Health firmly believes our success as a health plan hinges on our participating providers. Very simply, we cannot serve our members without you. As a local, county-sponsored health plan, we are quite literally owned by the residents of the counties we serve, including our providers. Because of this, our operation is designed to reflect the needs and interests of our members and providers. For example, our provider administrative policies and procedures are developed, monitored, and revised with the assistance of network providers who participate on several PrimeWest Health provider-based committees. The goal of provider participation in PrimeWest Health governance is to strike a more "provider friendly" balance between what providers desire from a health plan and what is required of PrimeWest Health under Federal and State laws.
Given the integral nature of our relationship with our counties, it should not be surprising that PrimeWest Health continually monitors provider and member satisfaction. We do this by responding to the results of our regular provider satisfaction surveys and to the provider questions, concerns, and comments voiced to the PrimeWest Health Provider Contact Center and Provider Services staff. To see the results of our most recently completed PrimeWest Health Provider Satisfaction Survey and member surveys, click on any of the titles below.
- Provider Satisfaction Survey
- Health Outcomes Survey (HOS)
- Consumer Assessment of Health Care Providers and Systems (CAHPS) survey
For more information about how to become a contracted network provider, contact the Provider Contact Center.
PrimeWest Health is owned by the 13 rural Minnesota counties we serve. Because we are locally owned, our members and the health and social services providers who serve them are our neighbors. As we work to fulfill our mission of providing an affordable, local option for health care coverage, we always strive to operate our health plan in a friendly, sensitive, neighborly manner.
As neighbors, we stress treating our members as individuals and addressing each member's unique health and wellness needs. For example, because we are owned by our counties, we have a direct partnership with county social services and public health providers to provide care management services to our members. Our care coordination staff works in tandem with county case management staff to ensure customized and coordinated care for our members. We believe that this integrated care coordination model offers the most comprehensive, cost-effective way of delivering services in a very individualized way to our members.Learn more about our member counties.