Request to be a contracted provider

Before providing services to Hennepin Health members, you must be contracted with us. Any claims submitted before an effective contract date will be processed as out of network or may be denied.

How to apply

A request for a contract is not a guarantee that you will receive a contract. The contract assessment process takes 60-90 calendar days.

1. Complete the contract request packet

• Contract request form (PDF)
• Network provider information form (PDF)

2. Complete the following documents:

• W-9/ACH form
• Disclosure of ownership form  
• Health services checklist (PDF)
• Location and practitioner roster- refer to the registration guide to determine your group or facility status
• Minnesota Secretary of State license verification 

- Provide proof of your current business filing.
- Obtain a copy of the filing document at the link above.

• Submit the documents requested in step 1 and 2 to hhnetworkmanagement@hennepin.us.

Credentialing and site visits

If you are approved to contract, you may be required to be credentialed or have a site visit. Our contracting and credentialing teams work in tandem to complete this process.

Credentialing 

Site visits 

Contract questions

Contact the Hennepin Health Network Management team at HHNetworkManagement@hennepin.us.