Eligible Providers

Practitioner credentialing is required for participating licensed independent practitioners whom PrimeWest Health members are directed to for primary, specialty, dental, or behavioral health care services. Practitioners who practice exclusively in an inpatient setting, free-standing facilities, or who provide care to members only because the member is directed to the facility, or who do not provide direct care for members (e.g., consultants) are not credentialed with PrimeWest Health.

The following providers of health care may be eligible for enrollment in PrimeWest Health. Provider types marked with an asterisk (*) may not receive direct payment for the services they provide; they must bill through an agency.

  1. Advanced Practice Registered Nurse (APRN)
  2. Ambulatory Surgical Center (ASC)
  3. Audiologist
  4. Certified Nurse Midwife (CNM)
  5. Certified Registered Nurse Anesthetist (CRNA)
  6. Certified Traditional Midwife/Certified Professional Midwife (CPM)
  7. Children’s Residential Treatment*
  8. Child and Teen Checkup (C&TC) Clinic
  9. Chiropractor
  10. Clinical Nurse Specialist (CNS)
  11. Community Health Clinic (CHC)
  12. Community Mental Health Center (CMHC)
  13. County Contracted Mental Health Rehabilitative Services
  14. County Human Services Agency
  15. Customized Living (CL)
  16. Day Training and Habilitation (DT&H) Day Activity Center
  17. Day Treatment Program
  18. Dental Practitioners
  19. Elderly Waiver (EW)/Home and Community Based Services (HCBS)
  20. Family Planning Agency
  21. Federally Qualified Health Center (FQHC)
  22. Freestanding Birth Center
  23. Head Start Agency
  24. Health Care Case Coordinator
  25. Hearing Aid Dispenser
  26. Home Health Agency
  27. Hospice
  28. Hospital
  29. Intermediate Care Facility for the Developmentally Disabled (ICF/DD)
  30. Independent Diagnostic Testing Facility
  31. Independent Laboratory
  32. Indian Health Service (IHS)
  33. Institution for Mental Disease (IMD)*
  34. Licensed Alcohol and Drug Counselor (LADC)
  35. Licensed Independent Clinical Social Worker (LICSW)
  36. Licensed Marriage and Family Therapist (LMFT)
  37. Licensed Professional Clinical Counselor (LPCC)
  38. Licensed Psychologist (LP)
  39. Long-Term Care Facility (Nursing Home)
  40. Medical Supply/Durable Medical Equipment (DME)
  41. Medication Therapy Management (MTM) Services
  42. Medical Transportation
  43. Mental Health Targeted Case Management (MH-TCM) for Serious and Persistent Mental Illness (SPMI)/Severe Emotional Disturbance (SED)
  44. Certified Nurse Practitioner (CNP)
  45. Occupational Therapist (OT)
  46. Optical Company
  47. Optometrist
  48. Personal Care Assistant (PCA)/CFSS Direct Support Worker 
  49. Personal Care Provider Organization (PCPO)
  50. Personal Care Assistant (PCA), Independent*
  51. Pharmacy
  52. Physical Therapist (PT)
  53. Physician (MD, DO, MBBS, MBBCh)
  54. Physician Assistant (PA)
  55. Podiatrist
  56. Private Duty Nurse (PDN Agency
  57. Psychiatrist
  58. Psychologist
  59. Public Health Clinic
  60. Public Health Nursing Agency
  61. Regional Treatment Center (RTC)
  62. Rehabilitation Agency
  63. Renal Dialysis
  64. Rural Health Clinic (RHC)
  65. Skilled Nursing Facility (SNF)
  66. Speech-Language Pathologist (SLP)
  67. Substance Use Disorder (SUD)
  68. Waiver (Home and Community Based Services Provider)
  69. X-Ray

Distribution of Written Materials to Practitioners

From time to time, PrimeWest Health distributes written materials or information to practitioners. In cases where PrimeWest Health has contracted with the facility or clinic in which the practitioner practices, the written materials or information will be sent to the clinic or facility administrator, office manager, or other designated office staff member. The administrator, office manager, or other designated office staff member is responsible for distributing such written materials or information to the practitioners.

Nondiscrimination Notice

All PrimeWest Health-enrolled providers must post a notice of nondiscrimination practices that is clearly visible in all of the following locations:

  1. Physical locations where you interact with the public
  2. The home page of your company’s website (in an easily accessible location)
  3. In any significant publications and communications that target PrimeWest Health members or the public
  4. The nondiscrimination notice must include all of the following information:
    1. Your organization does not discriminate on the basis of race, color, national origin, sex, age, or disability
    2. You provide appropriate accommodations for people with disabilities in a timely manner and free of charge, when they are needed to perform services. Appropriate accommodations include assistive devices and services, interpreters and information in alternate formats
    3. You provide timely language assistance services for people with limited English proficiency (LEP) free of charge, when they are needed to perform services. Language assistance services include translated documents and oral language interpretation
    4. How someone can obtain accommodations or language assistance services from you
    5. The name and contact information of an employee of your organization someone can contact to file a complaint about any of the items covered in the nondiscrimination notice
    6. Information about filing a complaint with the Office for Civil Rights (OCR)
    7. Taglines in at least the top 15 languages spoken by people with LEP in the state in which you operate, indicating that language assistance services are free of charge

For small publications or communications, such as postcards or tri-fold brochures, the nondiscrimination statement may contain no less than the following information:

  1. Statement that your organization does not discriminate on the basis of race, color, national origin, sex, age, or disability
  2. Taglines in at least the top two languages spoken by people with LEP in the state in which you operate indicating that language assistance services are free of charge

Medicare Enrollment Denials

If Medicare denies any of the following provider types from enrolling as a Medicare provider, the provider must submit the denial letter they received from Medicare to PrimeWest Health attesting that they cannot enroll:

  1. Licensed Independent Clinical Social Worker (LICSW)
  2. Licensed Psychologist (LP)
  3. Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) with a mental health specialty
  4. Mental Health Counselor
  5. Licensed Marriage and Family Therapist

These providers require either a Medicare Explanation of Payment (EOP) or must submit a Medicare Opt-Out Affidavit. 

If a provider cannot provide a Medicare denial letter, a completed Mental Health Professional Applicant Assurance Statement – Medicare Enrollment Denial (DHS-3864) form may be faxed to the PrimeWest Health Provider Contact Center at 1-320-335-5285. If PrimeWest Health does not receive a Medicare denial letter or DHS Attestation every 18 months after the date of initial Medicare denial, claims will deny.

 

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Updated_11/26/2025