Request to be a contracted provider

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.

Please complete the following and submit the documents to HHNetworkManagement@hennepin.us: 

• Contract request form (PDF, 1MB)
• Network provider information form (PDF, 1MB)
• W-9/ACH form
• Disclosure of ownership form  
• Location and practitioner roster (XLSX, 1MB)- 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.

Contract questions

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