Log in
Our website no longer supports Internet Explorer. For the best browsing experience, we recommend using Chrome, Safari, Edge or Firefox.

Medical/Behavioral Health contract request

Tell us about your organization

* All questions require answers, unless marked Optional
Indicate the years of operation for your organization:
Do any of your practitioners currently work for any other HealthPartners-contracted provider organizations?
Do practitioner homes serve as the place of service for in-person patient care?
Does your organization treat all patients, whether enrolled in Commercial, Medicare, or Medical Assistance insurance plans?
Select the age range(s) of your patient population: (Select at least one)
Are all practitioners enrolled with Medicare and eligible to see Medicare patients?
Does your location(s) have staff members that speak a language other than English?
Does your practice offer after-hours services?

Business hours

* Select at least one day

From
To
Tell us about any government program designations:
Tell us about any cultural competencies: (Optional)
Cancel |