Provider Network Adequacy

A network is a group of health care providers with which health plan companies contract to provide health care services to enrollees who purchase coverage. A health plan’s network includes providers that deliver primary care services, mental health services, general hospital services, specialty physician services, specialized hospital services, and other health services. Enrollees often receive the most coverage at the lowest cost when they use a provider in their network.

The Managed Care Systems Section is responsible for certifying health care provider networks for Health Maintenance Organizations (HMO) and Insurance Companies, including physicians, specialists, clinics, hospitals, and other providers. In Minnesota the provider networks must meet geographic access standards and include a sufficient number and type of providers to ensure that covered services are available to all enrollees without unreasonable delay.

For more information on topics related to provider networks, click on the links below:

• Individual Market Networks
• Small Group Market Networks
• Network Adequacy Filing Requirements
• Provider Network Waivers and Service Area Maps
• Accuracy Fact Sheet: Verification of Health Care Provider Information (PDF)

For more information, email health.managedcare@state.mn.us.