Requirements All Providers Must Meet

Providers who choose to participate in PrimeWest Health must meet professional requirements and/or licensure requirements as set forth in applicable State and Federal laws and regulations.

    Coordination of Services

    Each provider is responsible to ask the member if he/she is currently receiving the same health care services from another provider. If the member is receiving the same services from another provider, the people providing services must coordinate the services and document, in the member’s record, that coordination occurred. PrimeWest Health does not make this information available to providers.

    Document Retention

    Providers must retain documentation of services provided and claims submitted for at least 10 years. Documentation of services provided must include all relevant information to support the services billed. Documentation of claims submitted must include payments, settlements, or denials, including those from other payers.

    Cultural Competency

    The PrimeWest Health definition of Cultural Competency was adapted from the Minnesota Department of Human Services (DHS) Cultural Competency web page at https://mn.gov/dhs/partners-and-providers/training-conferences/childrens-mental-health/cultural-competency.jsp

    Culture influences an individual’s health and mental health beliefs, practices, behaviors, and even the outcomes of interventions. Health behavior depends on how one understands the cause of illness. In mental health and medicine, research indicates that culturally appropriate service improves diagnostic accuracy, increases adherence to recommended treatment, and reduces inappropriate emergency room and hospital use.

    Cultural competency is the ability and the will to respond to the unique needs of a member that arise from the member’s culture. Cultural competency is also the ability to use the member’s culture as a resource or tool to assist with the intervention and help meet their needs. This approach to serving others views, cultural values, and traditions as strengths can play an important part in serving our members’ needs. Minnesota consists of many diverse populations and cultures, which are growing all the time, making it vital to develop culturally and linguistically competent providers capable of delivering culturally appropriate services.

    Health care and mental health disparities are closely connected to race, culture, ethnicity, and poverty. Due to a variety of barriers, some services are less available and accessible for people of color and other groups, such as children and youth; deaf and hard of hearing; and gay, lesbian, bisexual, and transgender (GLBT) people. PrimeWest Health is continually working to address policies to improve treatment planning and practices related to cultural competency and health disparities.

    Cultural competency, combined with clinical standards, improves the quality of health care for members from diverse communities. It works to ensure equal access and non-discriminatory practices in service delivery.  

    PrimeWest Health is required by DHS to indicate which of our in-network providers have completed cultural competency learning in their organization. PrimeWest Health requires all contracted providers to annually complete cultural competency learning in order to participate in the PrimeWest Health network.

    Staff Diversity

    Provider organizations must have policies and procedures in place that address staff diversity. This can include strategies for recruitment, retention, and promotion at all levels of the organization.

    • A diverse staff is defined as being demographically representative of the community that the provider organization serves. Staff diversity plays an important role in how the organization responds to the needs of the people it serves.
    • Provider organizations may incorporate cultural attitudes and messages in internal communications, which can lead to increased trust in the workplace and staff retention.

    Staff Education and Learning

    Provider organizations must ensure that staff at all levels and across all disciplines receive ongoing education and learning in culturally and linguistically appropriate services. Because minority groups are composed of multiple subcultures, it may not be possible to provide in-depth learning on all cultures; however, some points to consider in learning/education include the following:

    • Simply maintaining a diverse staff is not sufficient in meeting the requirement of providing culturally competent care.
    • Ongoing education and learning that is based on the needs of the organization’s staff at all levels and relevant to the needs of the community is essential for ensuring culturally competent care.
    • Organizations should educate their health care providers on the traditional beliefs and behaviors of the populations they most commonly serve. 
    • Educational content should emphasize the development of skills that allow staff and health care professionals to effectively ask questions, especially regarding medical care, of individuals with culturally diverse backgrounds.
    • Staff learning and education topics can include, but are not limited to, the following:
      • Antiracism
      • Implicit bias
      • Bias reduction
      • Microaggressions
    • Learning and education should expand the staff’s knowledge base so that they can provide the most culturally appropriate treatment options.
    • Providers should be able to detail why specific learning topics were selected and how the learnings help improve their cultural competency as it specifically relates to their community and the populations they serve.

    Model of Care (MOC)

    Contracted providers and appropriate staff involved in Interdisciplinary Care Teams (ICTs) and care of PrimeWest Health members must annually complete MOC training. The PrimeWest Health MOC training resources can be found in the Provider Web Portal.

    Monthly Exclusion Screening

    Minnesota Law (MN Stat. 256B.064, subd. 3) requires providers to check the DHS exclusion list on a monthly basis, to document the date and time the list was checked, and to document the name and title of person who checked the exclusion list.

    DHS and PrimeWest Health understand the term “vendor” to include professionals, transportation companies, personal care assistance (PCA) agencies, hospitals, and other individuals and entities who submit claims for Medical Assistance (Medicaid)-covered services. Vendors are required to check their employees and contractors, even if the individual or entity is not responsible for direct patient care or direct submission of claims for Medical Assistance (Medicaid)-covered services.

    For more information, review PrimeWest Health’s Helpful State & Federal Compliance Links web page. 
     

     

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    Updated_08/08/2025