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Managed Care Systems

  • MCS Home
  • HMO Reporting, Bulletins and Reports

For Consumers

  • Enrollee External Appeals and Complaints
  • Mental Health Parity
  • The No Surprises Act
  • Provider Network Adequacy
  • HMO Quality Audits and HEDIS Measures
  • FAQs

For HMOs, CBPs, and Providers

  • Essential Community Providers
  • HMO Licensure
  • Health Plan Reporting Requirements
  • Network Adequacy Filing Requirements

About Minnesota HMOs

  • About HMOs and CBPs
  • Contact Us

Related Sites

  • Health Information Clearinghouse
  • Health Care Facilities, Providers and Insurance

Managed Care Systems

  • MCS Home
  • HMO Reporting, Bulletins and Reports

For Consumers

  • Enrollee External Appeals and Complaints
  • Mental Health Parity
  • The No Surprises Act
  • Provider Network Adequacy
  • HMO Quality Audits and HEDIS Measures
  • FAQs

For HMOs, CBPs, and Providers

  • Essential Community Providers
  • HMO Licensure
  • Health Plan Reporting Requirements
  • Network Adequacy Filing Requirements

About Minnesota HMOs

  • About HMOs and CBPs
  • Contact Us

Related Sites

  • Health Information Clearinghouse
  • Health Care Facilities, Providers and Insurance
Contact Info
Managed Care Systems
651-201-5100
800-657-3916 (toll-free)
health.mcs@state.mn.us

Contact Info

Managed Care Systems
651-201-5100
800-657-3916 (toll-free)
health.mcs@state.mn.us

Managed Care Systems

Regulating Health Maintenance Organizations, Provider Network Adequacy, and Consumer Services

The Managed Care Systems Section three primary functions:

  1. Regulatory oversight on all Health Maintenance Organizations (HMOs) and County-Based Purchasers (CBPs). Regulatory activities include:
    • Licensing HMOs in Minnesota.
    • Ensuring HMOs and CBPs are following state and federal laws.
    • Ensuring HMOs and CBPs are providing quality care and are financially stable.
    • Reviewing individual and small employer health plans to make sure they meet requirements under the Affordable Care Act.
  2. Provider Network Adequacy: This area focuses networks of health care providers that HMOs and health insurance companies have contracts with. Network Adequacy activities include:
    • Reviewing health care provider networks for individual and small employer health insurance plans to determine if they meet statutory requirements.
    • Designating Essential Community Proivders.
    • Engaging stakeholders in modernizing and prioritizing network adequacy activities.
  3. Consumer Services: This area provides information on health insurance resources, and helps consumers resolve complaints, which includes:
    • Helping consumers with HMO complaints.
    • Helping consumers file external appeals from HMOs.
    • Helping with No Surprises Act (balance billing) complaints.
    • Providing information and consumer education on health insurance and resources for finding care through the Health Information Clearinghouse.

Updates:

NEW! Information on cost sharing for prescription drugs related to diabetes, asthma and certain allergies.

  • For Consumers

  • HMO Enrollee Complaint and External Review Process
  • Health Information Clearinghouse
  • Mental Health Parity
  • No Surprises Act
  • Provider Network Adequacy
  • Quality Assurance and Performance Management
  • FAQs
  • About Minnesota HMOs

  • About HMOs and CBPs in Minnesota
  • List of HMOs CBPs
  • For HMOs, CBPs and Providers

  • Essential Community Providers
  • HMO Licensure
  • Health Plan Reporting Requirements
  • Network Adequacy Filing Requirements
  • Quality Assurance Examinations – coming soon!
  • About Managed Care Systems

  • HMO Reporting, Bulletins and Reports
  • How to Contact the Managed Care Section
 
Tags
  • insurance
Last Updated: 05/07/2025

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