Primary Care Network Listing. October 2015 through March Metropolitan Health Plan DHS-6594Q-ENG 10-15

Transcription

1 DHS-6594Q-ENG Primary Care Network Listing October 2015 through March 2016 Metropolitan Health Plan Cornerstone Solutions Member Services: This health plan may not cover all your health care costs. Read your contract (Evidence of Coverage) carefully to find out what is covered.í Cornerstone Solutions is a Coordinated Care plan with a Medicare contract and a contract with the Minnesota Medicaid program. SNBC: Hennepin County

2 This information is available in other forms to people with disabilities by calling (voice/toll free) (TDD) or 711 Minnesota Relay direct access numbers at (TTY, Voice, ASCII, Hearing Carryover), or (speech-to-speech relay service) American Indians can continue or begin to use tribal or Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For enrollees age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral. Cornerstone Solutions will accept all eligible people who choose or are assigned to the Plan. We will not discriminate in regard to physical or mental condition, health status, need for or receipt of health services, claims experience, medical history, genetic information, disability, marital status, age, sex, sexual orientation, national origin, race, color, religion or political beliefs. Cornerstone Solutions will not use any policy or practice that has the effect of such discrimination. Enrolling in this plan does not guarantee you can see a particular provider on this list. If you want to make sure, you should call that provider to ask whether he or she is still part of this health plan. You should also ask if he or she is accepting new patients. This health plan may not cover all your health care costs. Read your contract, or Evidence of Coverage carefully to find out what is covered. Metropolitan Health Plan Minneapolis Grain Exchange Building 400 South Fourth Street, Suite 201 Minneapolis, MN Member Services Cornerstone Solutions Fraud Hotline (TTY) Office Hours 8 a.m. 4:30 p.m., Monday Friday

3 T A B L E O F C O N T E N T S Introduction II Primary Care Clinics (PCC) You have the option of choosing one of the clinics from the following list. While you are not required to choose a PCC, we encourage you to see one provider for most of your care. The provider could be a primary care provider or a specialist. If the clinic or provider that you would like to see is not included in this list, call Cornerstone Solutions Member Services at Hospitals Urgent Care Clinics Walk-In Clinics Nursing Homes SNBC: Hennepin October 2015

4 I N T R O D U C T I O N Introduction to the Primary Care Network Listing Special Needs Basic Care (SNBC) is a voluntary managed care program that covers health care for people with disabilities who: are ages 18 through 64, and have Medical Assistance. Our SNBC program is called Cornerstone Solutions. Clinics The clinic information printed in this listing was correct as of 7/1/2015. You need to choose a primary care clinic when you enroll. Your primary care clinic can provide most of the health care services you need, and will help coordinate your care. Please confirm with Member Services that your clinic is still a provider with our health plan before signing up. Choose a clinic from the list on pages 1-26 to be your primary care clinic (PCC). Write the clinic s name and code in the space provided on the enrollment form. You will still be able to see any provider within the Cornerstone Solutions network for covered services. Cost Sharing You may be required to pay an amount toward some health care services. This is called cost sharing. You are responsible to pay your cost sharing amount to your provider. Members will receive an Evidence of Coverage (EOC) with more information about cost sharing. Member Identification (ID) Cards and Member Packet Members will get a health plan Member Identification (ID) card. This card must be shown whenever you get health care services, including getting a prescription filled. We will mail you a member packet and ID card. Service Accessibility If you need special access to get services from a provider, you can get information by calling Member Services at This could include, but is not limited to, access for services such as availability of flexible hours, wheelchair access or parking lot access. Service Authorization Our approval is needed for some services to be covered. The approval must be obtained before you get certain services or before we pay for them. You do not need a referral or service authorization to see a specialist within the Cornerstone Solutions network or a contracted Cornerstone Solutions provider. The Cornerstone Solutions provider network has a variety of specialists available. If your health care provider refers you outside of the Cornerstone Solutions network, authorization is required. The out-of-network specialist must be enrolled as a Minnesota Health Care Program (MHCP) provider, accept MHCP rates from Cornerstone Solutions and be willing to see Cornerstone Solutions members. Members will receive an EOC with more information about which services require authorization. II P R I M A R Y C A R E N E T W O R K L I S T I N G

5 I N T R O D U C T I O N Services Care Coordination Cornerstone Solutions will assign you a care guide who will work with you to develop a care plan based on your health care and social services needs. You can get more information on care coordination services by calling Member Services at (TTY: ). Chemical Dependency Chemical Dependency services provide care and treatment for chemical substance abuse, such as abuse of alcohol, narcotics or other drugs. Cornerstone Solutions provides chemical health services through a large network of providers. A list of these providers is available by calling Member Services. If you prefer, you can use any other licensed chemical dependency provider in Minnesota who is enrolled as a MHCP provider, will accept MHCP rates and is willing to see Cornerstone Solutions members. The Cornerstone Solutions care team can help you choose a provider based on the type of services you need and location most convenient to you. Call Member Services at (TTY: ). Chiropractic Care You may see any chiropractor who is enrolled as a MHCP provider, will accept MHCP rates from Cornerstone Solutions and is willing to see Cornerstone Solutions members. You can get information on chiropractic services by calling Member Services at (TTY: ). Dental A list of dental providers is provided in your directory. If you have questions about dental benefits or your dental claims, please call Delta Dental of Minnesota (Delta Dental) at or Delta Dental can also assist you with finding a dental provider, setting up your appointment, and arranging transportation or interpreter services if needed. Durable Medical Equipment (DME) Durable medical equipment is any medical equipment used in the home to aid in a better quality of living and provide therapeutic benefits to a patient with certain medical conditions or illnesses. Examples are nebulizers, wheelchairs, crutches and many others. You can get information on Durable Medical Equipment by calling Member Services at (TTY: ). Eye Care Cornerstone Solutions provides eye care services, including eye exams and glasses. A list of eye care providers is included in the Provider Directory. You can get information on eye care services by calling Member Services at (TTY: ). Home and Community Based Waiver Services for People with Disabilities We do not cover Home- and Community-Based Waiver Services for people with disabilities, but you may be eligible to get them through your county or tribe. Call your county or tribe to apply for these and other waiver services under the Community Alternatives for Disabled Individuals (CADI), Brain Injury (BI), Community Alternative Care (CAC) or Developmental Disability (DD) Waiver programs. These waiver programs offer more services than regular W W W. M H P 4 L I F E. O R G III

6 I N T R O D U C T I O N Medical Assistance. Services include extended home care, assisted living, supported employment and more. Home Care Home care services include skilled nursing, rehabilitation therapies (for example speech, physical, respiratory, and occupational), home health aide, medical equipment and supplies, Personal Care Assistant (PCA) and Home Care Nursing (HCN) services. You can get information on how to access home care services by calling Member Services at (TTY: ). We do not cover PCA or HCN services for SNBC members, but you may be able to get them through our county or tribe. Call your county or tribe to apply for these services. Hospitals Your PCC will use one of the hospitals listed on pages You can get more information on hospital services by calling Member Services at (TTY: ). Interpreter Services Spoken language and sign language interpreter services are available to help you get services. Oral interpretation can be given to you in your language. You may be able to get written information in your language. MHP offers interpreter services in-person and over the telephone. These services can be accessed by calling Member Services at (TTY: ). Mental Health Mental health services provide care and treatment for problems that affect your thoughts, mood and behavior, like depression, anxiety or other mental health issues that interfere with your daily functioning. Mental health services are provided by Cornerstone Solutions. To find out if a certain provider is available, call Member Services and ask for the list of providers. If you prefer, you can use any other licensed mental health provider in Minnesota who is enrolled as a MHCP provider, will accept MHCP rates and is willing to see Cornerstone Solutions members. The Cornerstone Solutions care team will help you choose a provider based on the type of services you need and location most convenient to you. Call Member Services at (TTY: ). Nursing Home Care We will cover a total of 100 days of nursing home care. If you need nursing home care beyond the 100 days, the Minnesota Department of Human Services (DHS) will pay for your stay in the nursing home care. The health plan will continue to pay for all health care costs. This applies unless you were already in the nursing home when you enrolled in the plan. You can get more information on nursing home services by calling Member Services at (TTY: ). Open Access Services You may choose to receive care from any physician, clinic, hospital, pharmacy or family-planning agency to get some services even if it is not in our network. The services are: family planning, diagnosis of infertility, testing and treatment of sexually transmitted diseases, and testing for AIDS or HIV-related conditions. You can get more information on open access services by calling Member Services at (TTY: ). Pharmacy Members must use our network of pharmacies for drugs covered by our health plan. A list of pharmacies is included in the Provider Directory. Remember to have the following available when you call to refill your prescription: IV P R I M A R Y C A R E N E T W O R K L I S T I N G

7 I N T R O D U C T I O N Cornerstone Solutions Member Identification (ID) card MHCP card Cards for any other health coverage you have such as Medicare Part D or private insurance It is important to remember to show both your Member Identification (ID) card and your MHCP card when picking up your prescriptions. People with Medicare must enroll in a Medicare Prescription Drug Program (Medicare Part D) to get most of their drugs. You can get more information on pharmacy services by calling Member Services at (TTY: ). Specialty Care Specialty Care describes services you can get from doctors or surgeons whose training focuses primarily in one specific field of medicine, such as neurology, cardiology, or oncology, among others. Cornerstone Solutions offers a large specialty network. You can get information on how to access specialty care by calling Member Services at (TTY: ). Spenddowns SNBC members who have an income over a certain limit may have to pay an amount each month called an institutional or medical spenddown. SNBC members with an institutional spenddown continue to pay their spenddown to the facility in which they live. Members who do not pay their spenddowns as required will be disenrolled from SNBC. People with a medical spenddown are not eligible to enroll in SNBC. examples of these services are: orthodontia, mental health, chemical dependency, at-risk pregnancy or prescriptions. If you are currently receiving care from a provider who is not in our provider network, we will help you transition to a participating provider. Transportation We are not required to provide transportation to your primary care clinic if it is more than 30 miles from your home if a primary care clinic is available within 30 miles. Exceptions to rides more than 30 miles from your home can be made in certain circumstances. If you need a ride and a closer clinic in our network is not available, please call Member Services at (TTY: ). Cornerstone Solutions transportation services can help you get a free ride to your health care appointments. Members will receive an EOC with more information about transportation. Urgent/After Hours/Emergency Care When you need medical care during regular business hours, it is best to call your primary care clinic. When you need care after hours, or when you have injuries or illnesses that are not life-threatening, you have options: Call HealthConnection, MHP s 24/7 nurse line, at ; or Go to any of the urgent care clinics listed on pages In an emergency that needs treatment right away, call 911 or go to the nearest emergency room. Transition of Care When you join Cornerstone Solutions, we will help you continue to get necessary health care services that were authorized before you enrolled with us. Some W W W. M H P 4 L I F E. O R G V

8 I N T R O D U C T I O N Cornerstone Solutions has a multilingual Member Services staff. For Cornerstone Solutions recorded translated plan information, call: VI P R I M A R Y C A R E N E T W O R K L I S T I N G

9 You can get updated information about listed providers and information on specialists that are not listed in this booklet by calling Member Services at (TTY: ). Anoka County Andover Clinics, Andover Clinic Code: Hanson Blvd NW Andover, MN , Lakes & Urgent Care Blaine Allina Health Blaine Clinic Clinic Code: Town Square Dr NE Suite 100 Blaine, MN Practice, Geriatrics and I nternal Medicine Hospital Affiliation: Unity Hospital, Mercy Hospital Clinics, Blaine Clinic Code: Club W Parkway NE Blaine, MN , Lakes & Urgent Care North Memorial Clinic, Silver Lake (Blaine) Clinic Code: th Ave NE, Suite 110 Blaine, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation Columbia Heights Clinics, Columbia Heights Clinic Code: Central Ave NE Columbia Heights, MN , Lakes & Urgent Care Coon Rapids Allina Health Urgent Care Coon Rapids Clinic Clinic Code: Springbrook Dr Coon Rapids, MN Practice, Geriatrics and Internal Medicine Hospital Affiliation: Unity Hospital, Buffalo Hospital, Cambridge, Hennepin County Medical Center, Mercy Hospital Allina Health Mercy Women s Health Clinic Clinic Code: Blackfoot St NW, Suite 300 Coon Rapids, MN Hospital Affiliation: Unity Hospital, Mercy Hospital Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 1

10 Fridley Allina Health Fridley Clinic Clinic Code: 1021 Unity Professional Building 500 Osborne Rd NE, Suite 255 Fridley, MN Hospital Affiliation: Unity Hospital, Mercy Hospital, United Hospital Allina Health Unity Hospitalist Clinic Code: 4088 Unity Hospital 550 Osborne Rd NE Fridley, MN Hospital Affiliation: Unity Hospital, Mercy Hospital Clinics, Fridley Clinic Code: University Ave NE Fridley, MN Hospital Affiliation: Unity Hospital, University of Minnesota Fridley Children s & Teenagers Clinic Code: NE Osborne Rd, Suite 215 Fridley, MN Hospital Affiliation: Unity Hospital, Mercy Hospital Lino Lakes Clinics, Lino Lakes Clinic Code: Village Dr Lino Lakes, MN Lakes & Urgent Care, Northland Hospital Ramsey Allina Health Ramsey Clinic Clinic Code: Sunwood Drive NW Ramsey, MN Hospital Affiliation: Mercy Hospital, Unity Hospital St. Francis Clinics, St. Francis Clinic Code: St. Francis Blvd St. Francis, MN Lakes & Urgent Care, University of Minnesota Carver County Chanhassen Ridgeview Chanhassen Clinic Clinic Code: Powers Blvd Chanhassen, MN Northwestern Hospital Western OB/Gyn, Chanhassen Clinic Code: Powers Blvd Chanhassen, MN Hospital Affiliation: Ridgeview Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 2 P R I M A R Y C A R E N E T W O R K L I S T I N G

11 Chaska Allina Health Chaska Clinic Clinic Code: Hundertmark Rd Chaska, MN Hospital Affiliation: St. Francis Regional Ridgeview Chaska Clinic Clinic Code: Hundertmark Rd, Suite 115N Chaska, MN Hospital Affiliation: Ridgeview South Lake Pediatrics, Chaska Clinic Code: Hundertmark Rd, Suite 210 Chaska, MN Hospital Affiliation: Ridgeview, Maple Grove Hospital Valley Family Practice Clinic Code: Yellow Brick Rd Chaska, MN Hospital Affiliation: St. Francis Regional, Glencoe Regional Health Services Glencoe Hospital Wayzata Children s Clinic, Chaska Clinic Code: Hundertmark Rd, Suite 13 Chaska, MN Patients under age 20 Northwestern Hospital, St. Francis Regional, Ridgeview Waconia Premier OB/GYN of Minnesota Clinic Code: S Maple St, Suite 130 Waconia, MN Hospital Affiliation: Ridgeview Ridgeview, Waconia Clinic Code: S Maple St Waconia, MN Hospital Affiliation: Children s Health West Plymouth, Children s Hospital Minneapolis, Ridgeview Watertown Catalyst Medical Clinic, Watertown Clinic Code: Lewis Ave, Suite 201 Watertown, MN Hospital Affiliation: Ridgeview Chisago County Chisago City Clinics, Chisago City Clinic Code: Stinson Ave Chisago City, MN , Lakes & Urgent Care Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 3

12 North Branch Allina Health North Branch Clinic Code: th Ave N North Branch, MN Hospital Affiliation: Unity Hospital, Cambridge Medical Center Clinics, North Branch Clinic Code: St North Branch, MN Lakes & Urgent Care, University of Minnesota Rush City Clinics, Rush City Clinic Code: W 4th St Rush City, MN Lakes & Urgent Care Wyoming Lakes Regional Clinic Code: 4026 Lakes 5200 Blvd Wyoming, MN Lakes Regional Dakota County Apple Valley Apple Valley Clinic Code: Galaxie Ave Apple Valley, MN Ridges Hospital Clinics, Apple Valley Clinic Code: Cedar Ave S Apple Valley, MN Ridges Hospital, University, Southdale Hospital Burnsville Allina Health Burnsville Clinic Clinic Code: Nicollet Ave S Burnsville, MN Northwestern Hospital Burnsville Family Physicians Clinic Code: 4007 Oak Ridge Professional Building 625 E Nicollet Blvd, Suite 100 Burnsville, MN Ridges Hospital, Southdale Hospital Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 4 P R I M A R Y C A R E N E T W O R K L I S T I N G

13 Clinics, Burnsville Clinic Code: E Nicollet Blvd Burnsville, MN Ridges Hospital, University of Minnesota, Southdale Hospital Southdale Ob/Gyn Consultants, Burnsville Clinic Code: 4076 Ridges Hospital 305 E Nicollet Blvd, Suite 393 Burnsville, MN Ridges Hospital Southdale Pediatric Associates, Burnsville Clinic Code: E Nicollet Blvd, Suite 200 Burnsville, MN Ridges Hospital Trinity Integrative Medicine Clinic Code: E 117th St, Suite 200 Burnsville, MN Ridges Hospital Eagan Allina Health Eagan Clinic Clinic Code: Yankee Doodle Rd Eagan, MN Hospital Affiliation: Children s Hospital St. Paul, Southdale Hospital, United Hospital Allina Health Eagan Women s Clinic Clinic Code: Dodd Rd, Suite 100 Eagan, MN Hospital Affiliation: United Hospital Clinics, Eagan Clinic Code: 4019 Eagan Medical 1440 Duckwood Dr Eagan, MN Ridges Hospital, University, Southdale Hospital Farmington Allina Health Farmington Clinic Clinic Code: Chippendale Ave W Farmington, MN Northwestern Hospital, Regina Clinics, Farmington Clinic Code: Pilot Knob Rd Farmington, MN Ridges Hospital Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 5

14 Hastings Lakeville Allina Health First Street Clinics, Lakeville Clinic Code: 1022 Clinic Code: 4028 Hospital Affiliation: Children s 1210 First St W Joplin Ave Hospital St. Paul, United Hospital Hastings, MN Lakeville, MN Hospital Affiliation: Regina, United Hospital Allina Health Nininger Road Clinic Code: Nininger Rd Hastings, MN Hospital Affiliation: Regina, United Hospital Inver Grove Heights Allina Health Inver Grove Heights Clinic Clinic Code: Blaine Ave Inver Grove Heights, MN Hospital Affiliation: Children s Hospital Minneapolis, United Hospital Ridges Hospital, University, Southdale Hospital Rosemount Clinics, Rosemont Clinic Code: Cimarron Ave Rosemount, MN Hospital Affiliation: Children s Hospital St. Paul, Ridges Hospital West St. Paul Allina Health West St. Paul Clinic Code: E Emerson Ave West St. Paul, MN Mendakota Pediatrics Clinic Code: Livingston Ave, Suite 102 West St. Paul, MN Hospital Affiliation: Children s Hospitals & Clinics Hennepin County Bloomington Allina Health Bloomington Clinic Clinic Code: Old Cedar Ave S Bloomington, MN Practice, Geriatrics and Internal Medicine Hospital Affiliation: Children s Hospital Minneapolis, Abbott Northwestern Hospital Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 6 P R I M A R Y C A R E N E T W O R K L I S T I N G

15 Clinics, Bloomington Lake Xerxes Clinic Code: Xerxes Ave S, Suite 116 Bloomington, MN Southdale Hospital Clinics, Bloomington Oxboro Clinic Code: W 98th St Bloomington, MN Ridges Hospital, University, Southdale Hospital Brooklyn Center Brooklyn Center Clinic, Hennepin Clinic Code: Shingle Creek Parkway Suite 400 Brooklyn Center, MN North Memorial Clinic, Brooklyn Center Clinic Code: Xerxes Ave N, Suite D Brooklyn Center, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation Brooklyn Park Allina Health Brooklyn Park Clinic Clinic Code: Noble Parkway E Brooklyn Park, MN Hospital Affiliation: Mercy Hospital, United Hospital Brooklyn Park Clinic, Hennepin Clinic Code: Zane Ave N Brooklyn Park, MN Crown, Brooklyn Park Clinic Code: th Ave N Brooklyn Park, MN Clinics, Brooklyn Park Clinic Code: Zane Ave N Brooklyn Park, MN North Memorial Clinic, Brooklyn Park Family Physicians Clinic Code: Edinbrook Pkwy, Suite 100 Brooklyn Park, MN Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 7

16 Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation Champlin Allina Health Champlin Clinic Clinic Code: Jefferson Highway N Champlin, MN Hospital Affiliation: Unity Hospital, Mercy Hospital, United Hospital Crystal Ob/Gyn West, Crystal Clinic Code: Bottineau Blvd, Suite 210 Crystal, MN (Riverside) Eden Prairie Clinics, Eden Prairie Clinic Code: 4020 Eden Center 830 Prairie Center Dr Eden Prairie, MN For Mental Health appointments call Southdale Hospital Ob/Gyn West, Eden Prairie Clinic Code: Prairie Center Dr, Suite 130 Eden Prairie, MN Hospital Affiliation: Ridgeview South Lake Pediatrics, Eden Prairie Clinic Code: Prairie Center Dr, Suite 120 Eden Prairie, MN Hospital Affiliation: Children s Hospitals & Clinics of Minnesota Southdale Pediatric Associates, Eden Prairie Clinic Code: Cascade Dr, Suite 170 Eden Prairie, MN Hospital Affiliation: Children s Hospitals & Clinics of Minnesota Edina Abbott Northwestern General Medicine Associates, Edina Clinic Code: 1001 Abbott Northwestern Center for Outpatient Care 8100 W 78th St, Suite 100 Edina, MN Northwestern Hospital Allina Health Edina Clinic Clinic Code: France Ave S Edina, MN Northwestern Hospital Associates in Women s Health, Edina Clinic Code: Drew Ave S Edina, MN Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 8 P R I M A R Y C A R E N E T W O R K L I S T I N G

17 Southdale Hospital Clinic Sofia OB-GYN Clinic Code: 4008 Southdale Medical Building 6545 France Ave S, Suite 490 Edina, MN Southdale Hospital Diamond Women s Center Clinic Code: 4010 Southdale Medical Building 6545 France Ave S, Suite 540 Edina, MN Southdale Hospital Edina Edina Family Physicians Clinic Code: Vernon Ave S Edina, MN Southdale Hospital Edina Sports Health and Wellness Clinic Code: 4013 Physicians Building 6363 France Ave S, Suite 525 Edina, MN Southdale Hospital Clinics, Edina Clinic Code: 4018 Southdale Medical Building 6545 France Ave S Edina, MN Southdale Hospital France Avenue Family Physicians Clinic Code: France Ave S, Suite 410 Edina, MN Southdale Hospital Larson, Paul OB/GYN Clinic Clinic Code: 4052 Drew Professional Building 6525 France Ave S, Suite 100 Edina, MN Southdale Hospital Life Medical Clinic Code: W 76th St Edina, MN Southdale Hospital Minnesota Gynecology and Surgery Clinic Code: France Ave S, Suite 240 Edina, MN Southdale Hospital Obstetrics, Gynecology & Infertility, Edina Clinic Code: 4060 Southdale Hospital 6405 France Ave S, Suite W400 Edina, MN of Minnesota, Southdale Hospital Obstetrics/Gynecology Specialists, Edina Clinic Code: 4064 Southdale Medical Building 6545 France Ave S, Suite 600 Edina, MN Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 9

18 Ridges Hospital, Southdale Hospital Sharpe, Dillon, Cockson & Associates Clinic Code: France Ave S, Suite 100 Edina, MN Northwestern Hospital Southdale Internal Medicine Clinic Code: 4075 Southdale Medical Building 6545 France Ave S, Suite 510 Edina, MN Southdale Hospital Southdale Ob/Gyn Consultants, Edina Clinic Code: W 65th St, Suite 100 Edina, MN , Southdale Hospital Southdale Pediatric Associates, Edina Clinic Code: Parklawn Ave S, Suite 120 Edina, MN , Southdale Hospital Wright Medical Care Clinic Code: Metro Blvd, Suite 140 Edina, MN Southdale Hospital Edina Excelsior Ridgeview Excelsior Clinic Clinic Code: Water St Excelsior, MN Hospital Affiliation: Ridgeview Golden Valley HCMC Golden Valley Clinic Clinic Code: 5005 Spring Gate Shopping Center 5653 Duluth St Golden Valley, MN North Memorial Clinic, Golden Valley Family Physicians Clinic Code: Golden Valley Rd Golden Valley, MN Hospital Affiliation: North Memorial Hopkins Allina Health Hopkins Clinic Clinic Code: nd Ave S Hopkins, MN Practice, Geriatrics and Internal Medicine Northwestern Hospital Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 10 P R I M A R Y C A R E N E T W O R K L I S T I N G

19 Maple Grove Allina Health Maple Grove Clinic Code: Vinewood Lane Maple Grove, MN Hospital Affiliation: Unity Hospital, Buffalo Hospital, Mercy Hospital Clinics, Bass Lake Clinic Code: Wedgwood Rd N Maple Grove, MN , Maple Grove Clinic Code: th Ave N, Suite 100 Maple Grove, MN North Memorial Clinic, Arbor Lakes Clinic Code: Elm Creek Blvd, Suite 130 Maple Grove, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation North Memorial Clinic, Camden Physicians Maple Grove Clinic Code: Elm Creek Blvd, Suite 130 Maple Grove, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation North Memorial Clinic, Maple Grove Clinic Code: Hospital Dr, Suite 102B Maple Grove, MN Hospital Affiliation: North Memorial, Maple Grove Hospital South Lake Pediatrics, Maple Grove Clinic Code: 4071 Arbor Lakes Elm Creek Blvd, Suite 250 Maple Grove, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation Minneapolis Abbott Northwestern General Medical Associates, Minneapolis Clinic Code: Chicago Ave S, Suite 250 Minneapolis, MN Northwestern Hospital Allina Health East Lake Street Clinic Clinic Code: Snelling Ave S Minneapolis, MN Practice, Geriatrics and Internal Medicine Northwestern Hospital Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 11

20 Allina Health Isles Clinic Clinic Code: Hennepin Ave S Minneapolis, MN Practice, Geriatrics and Internal Medicine Northwestern Hospital Allina Health Nicollet Mall Clinic Code: 1028 Medical Arts Building 825 Nicollet Mall, Suite 300 Minneapolis, MN Northwestern Hospital Allina Health Uptown Clinic Clinic Code: W Lake St, Suite 201 Minneapolis, MN Northwestern Hospital Associates in Women s Health, Minneapolis Clinic Code: Nicollet Ave S, Suite 853 Minneapolis, MN Northwestern Hospital Axis Clinic Code: Nicollet Ave S, Suite 105 Minneapolis, MN Boynton Health Services, Minneapolis Clinic Code: Church St SE Minneapolis, MN , Children s Primary Clinic, Minneapolis Clinic Code: Chicago Ave S Minneapolis, MN Hospital Affiliation: Children s Hospital Minneapolis Community University Health Care Center-CUHCC Clinic Code: Bloomington Ave S Minneapolis, MN Practice, Geriatrics and Internal Medicine, Crown Clinic Code: st Ave Minneapolis, MN Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 12 P R I M A R Y C A R E N E T W O R K L I S T I N G

21 Clinics, Bloomington Lake Minneapolis Clinic Code: E Lake St, Suite 150 Minneapolis, MN of Minnesota, Southdale Hospital Clinics, Hiawatha Clinic Code: nd Ave S Minneapolis, MN of Minnesota, Southdale Hospital Clinics, Integrated Primary Care Clinic Code: 4289 Riverside Professional Building th Ave S, Suite 602 Minneapolis, MN Clinics, Northside Life Care Clinic Code: Thomas Ave N Minneapolis, MN Clinics, Riverside Clinic Code: 4279 Riverside Professional Building th Ave S, Suite 700 Minneapolis, MN Clinics, Southside Life Care Clinic Code: Chicago Ave Minneapolis, MN Clinics, University Childrens Clinic Code: University Ave SE Minneapolis, MN Patients up to age 16 Clinics, Uptown Clinic Code: Excelsior Blvd, Suite 275 Minneapolis, MN Green Central Community Clinic Clinic Code: E 35th St Minneapolis, MN Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 13

22 , University, HCMC BeWell Clinic Clinic Code: S 6th St, Suite A-119 Minneapolis, MN HCMC Coordinated Care Clinic Clinic Code: 0072 HCMC Campus 701 Park Ave Minneapolis, MN Available to patients by professional referral only. HCMC East Lake Clinic Clinic Code: E Lake St Minneapolis, MN HCMC Golden Valley Clinic Clinic Code: Duluth St Minneapolis, MN HCMC Internal Medicine Clinic at Parkside Clinic Code: 4270 Parkside Professional Center 825 S 8th St, Suite 206 Minneapolis, MN Multispecialty Clinic: Geriatrics and Internal Medicine HCMC International Health Clinic Clinic Code: 1092 HCMC Campus 701 Park Ave Minneapolis, MN Russian Primary Care - Monday 1pm-4pm Somali Primary Care: Monday 1pm-3:30pm Tuesday 1pm-4pm Spanish Primary Care: Monday & Friday 8am-4:30pm HCMC Medicine Clinic Clinic Code: 1093 HCMC Campus 701 Park Ave 5th Floor Purple Minneapolis, MN Russian, Somali, and Spanish Primary Care offered at 3 North location. Practice, Geriatrics and Internal Medicine HCMC Obstetrics/ Gynecology Clinic Clinic Code: 1094 HCMC Campus 701 Park Ave, P5 Minneapolis, MN HCMC Pediatric Clinic Clinic Code: 1095 HCMC Campus 701 Park Ave, P7 Minneapolis, MN , Children s Hospitals & Clinics of Minnesota Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 14 P R I M A R Y C A R E N E T W O R K L I S T I N G

23 HCMC Whittier Clinic Clinic Code: Nicollet Ave Minneapolis, MN Indian Health Board of Minneapolis, Inc. Clinic Code: E 24th St Minneapolis, MN , Abbott Northwestern Hospital Life Medical, Minneapolis Clinic Code: E Lake St, Suite 3300 Minneapolis, MN Native American Community Clinic Clinic Code: E Franklin Ave Minneapolis, MN Northwestern Hospital, Hennepin Neighborhood Healthsource, Sheridan Clinic Code: th Ave NE Minneapolis, MN HCMC certified nurse midwives practice here. Neighborhood Healthsource, Central Clinic Code: Central Ave NE Minneapolis, MN Neighborhood Healthsource, Fremont Clinic Code: Fremont Ave N Minneapolis, MN HCMC certified nurse midwives practice here. Practice and Geriatrics North Memorial Clinic, Camden Clinic Code: Webber Pkwy, Suite 130 Minneapolis, MN Hospital Affiliation: North Memorial North Memorial Clinic - Northeast Family Physicians Clinic Code: Central Ave SE Minneapolis, MN Hospital Affiliation: North Memorial NorthPoint Health & Wellness Center Clinic Code: Penn Ave N Minneapolis, MN Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 15

24 Hospital Affiliation: North Memorial, Hennepin Park Avenue Family Practice Clinic Code: Nicollet Ave S Minneapolis, MN Senior Care Clinic at Augustana, Hennepin Clinic Code: th Ave S Minneapolis, MN Multispecialty Clinic: Geriatrics and Internal Medicine Southside Medical Clinic Clinic Code: E 35th St Minneapolis, MN , Southdale Hospital University of Minnesota Physicians, Broadway Family Medicine Clinic Code: W Broadway Minneapolis, MN Mental health services available to clinic s medical patients only. Hospital Affiliation: University of Minnesota University of Minnesota Physicians, Mill City Clinic Clinic Code: S Second St, Suite A Minneapolis, MN University of Minnesota Physicians, Pediatrics Clinic Code: 1142 Phillips-Wagensteen Building 516 Delaware St SE Phillips Wangensteen Building Minneapolis, MN University of Minnesota Physicians, Primary Care Center Clinic Code: 1145 Phillips-Wagensteen Building 516 Delaware St SE Phillips Wangensteen Building Minneapolis, MN Practice, Geriatrics and Internal Medicine University of Minnesota Physicians, Smiley s Family Medicine Clinic Clinic Code: E 28th St Minneapolis, MN Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 16 P R I M A R Y C A R E N E T W O R K L I S T I N G

25 University of Minnesota Physicians Health NP Clinic Clinic Code: S 3rd St Minneapolis, MN Minnetonka North Memorial Clinic, Minnetonka Clinic Code: Highway 7, Suite 100 Minnetonka, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation North Memorial Clinic, Ridgedale Clinic Code: Plymouth Rd, Suite 100 Minnetonka, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Ob/Gyn West, Minnetonka Clinic Code: Ridgedale Dr, Suite 200 Minnetonka, MN Southdale Hospital, Maple Grove Hospital Odom Sports & Wellness Clinic Code: Wayzata Blvd Minnetonka, MN Southdale Hospital South Lake Pediatrics, Minnetonka Clinic Code: 4072 Children s West Medical Building 6060 Clearwater Dr, Suite 240 Minnetonka, MN Hospital Affiliation: Children s Hospital & Clinics of Minnesota Wayzata Children s Clinic - Minnetonka Clinic Code: Ridgedale Dr, Suite 100 Minnetonka, MN Patients under age 20 Hospital Affiliation: Children s Hospital Minneapolis Plymouth Abbott Northwestern General Medicine Associates, Plymouth Clinic Code: Campus Dr, Suite 325 Plymouth, MN Northwestern Hospital Allina Medical Clinic - West Health Campus Clinic Code: 1042 West Health Campus 2855 Campus Dr, Suite 400 Plymouth, MN Northwestern Hospital North Memorial Clinic, Camden Physicians Plymouth Clinic Code: Rockford Rd Plymouth, MN Hospital Affiliation: North Memorial Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 17

26 North Memorial Clinic - Richfield Plymouth City Center Southdale Hospital Allina Health Richfield Clinic Clinic Code: th Ave N Clinic Code: 1036 Plymouth, MN W 66th St Richfield, MN Hospital Affiliation: North Memorial North Memorial Clinic, Rockford Road Clinic Code: Rockford Rd Plymouth, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation South Lake Pediatrics, Plymouth Clinic Code: 4073 WestHealth Campus 2805 Campus Dr, Suite 235 Plymouth, MN Hospital Affiliation: Children s Hospitals & Clinics of Minnesota Practice, Geriatrics and Internal Medicine Northwestern Hospital HCMC Richfield Clinic Clinic Code: W 66th St Richfield, MN Life Medical, Richfield Clinic Code: Chicago Ave S Richfield, MN Southdale Hospital Richfield Medical Group Clinic Code: Nicollet Ave S Richfield, MN Southside Richfield Clinic Clinic Code: E 78th St Richfield, MN Rogers Clinics, Rogers Clinic Code: Northdale Blvd Rogers, MN Spring Park Ridgeview Westonka Clinic Clinic Code: Shoreline Dr Spring Park, MN Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 18 P R I M A R Y C A R E N E T W O R K L I S T I N G

27 Hospital Affiliation: Ridgeview St. Louis Park Winsted Life Medical Clinic Code: Excelsior Blvd St. Louis Park, MN Wayzata Children s Clinic, Spring Park Clinic Code: Shoreline Dr Spring Park, MN Patients under age 20 Hospital Affiliation: Children s Hospital Minneapolis, Ridgeview St. Anthony North Memorial Clinic, Silver Lake (St. Anthony) Clinic Code: th Ave NE St. Anthony, MN Hospital Affiliation: North Memorial, Maple Grove Hospital Corporation St. Anthony Village Clinic, Hennepin County Medical Center Clinic Code: Highway 88 St. Anthony, MN Southdale Hospital South Lake Pediatrics, St. Louis Park Clinic Code: Excelsior Blvd, Suite 131 St. Louis Park, MN Hospital Affiliation: Children s Hospitals & Clinics of Minnesota McLeod County Glencoe Glencoe Regional Health Services, Glencoe Clinic Clinic Code: 1152 Glencoe Area Health Center 1805 Hennepin Ave N Glencoe, MN Hospital Affiliation: Glencoe Regional Health Services Ridgeview Winsted Clinic Clinic Code: th St N Winsted, MN Hospital Affiliation: Ridgeview, Southdale Hospital Western OB/Gyn, Winsted Clinic Code: th St N Winsted, MN Hospital Affiliation: Ridgeview Ramsey County Maplewood Allina Health Urgent Care Maplewood Clinic Clinic Code: Beam Ave Maplewood, MN Practice and Geriatrics Hospital Affiliation: United Hospital Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 19

28 New Brighton Clinics - New Brighton Clinic Code: Silver Lake Rd New Brighton, MN Roseville Richard Schoewe, MD Clinic Code: Rice St N Roseville, MN Family Practice Schoewe, Richard W. Shoreview Allina Health Shoreview Clinic Clinic Code: N Lexington Ave Shoreview, MN Northwestern Hospital St. Paul Allina Health Urgent Care Bandana Square Clinic Clinic Code: Bandana Blvd E, Suite 100 St. Paul, MN Practice, Geriatrics and Internal Medicine Northwestern Hospital, United Hospital, Regions Hospital Allina Health Highland Park Clinic Code: Ford Parkway St. Paul, MN Practice, Geriatrics and Internal Medicine Hospital Affiliation: Regions Hospital, United Hospital Allina Health United Women s Clinic Clinic Code: 1031 Gardenview Medical Building 347 Smith Ave N, Suite 203 St. Paul, MN Hospital Affiliation: United Hospital Allina Medical Clinic, Parkview Medical Clinic, OB/GYN Clinic Code: Sherman St St. Paul, MN Hospital Affiliation: United Hospital Clinics - Highland Park Clinic Code: Ford Parkway St. Paul, MN Ridges Hospital, University Please select a clinic from this section. This clinic will be your Primary Care Clinic. You may go to any of the clinics in this booklet for covered services, without a referral. See your Evidence of Coverage for more information regarding referrals and prior authorizations. 20 P R I M A R Y C A R E N E T W O R K L I S T I N G

29 Virtual Care Clinic Code: Lexington Pkwy N, Suite 300 St. Paul, MN Indian Health Board Clinic, St. Paul Clinic Code: York Ave St. Paul, MN Life Medical, St. Paul Clinic Code: Rice St, Suite 202 St. Paul, MN Hospital Affiliation: United Hospital Open Cities Health Center Clinic Code: N Dunlap St St. Paul, MN Mental health services available to clinic s medical patients only. Hospital Affiliation: Regions Hospital, United Hospital Open Cities Health Center, Manitoba (North End) Clinic Code: Manitoba Ave St. Paul, MN Hospital Affiliation: United Hospital, Regions Hospital St. Paul Family Clinic Code: Payne Ave St. Paul, MN Mental health services available to clinic s medical patients only. Hospital Affiliation: United Hospital, Regions Hospital United Family Practice Clinic Code: W 7th St St. Paul, MN Practice, Geriatrics and Internal Medicine Hospital Affiliation: United Hospital United Family Practice Health Center, Sibley Plaza Clinic Code: W 7th St St. Paul, MN Afternoon hours only. Practice and Geriatrics Hospital Affiliation: United Hospital United Medical Specialties, St. Paul Clinic Code: 1041 John Nasseff 255 N Smith Ave, Suite 100 St. Paul, MN Hospital Affiliation: United Hospital University of Minnesota Physicians, Bethesda Clinic Clinic Code: Rice St St. Paul, MN Mental health services available to clinic s medical patients only. Obstetrics/gynecology is a direct access service. A female member may see any obstetrics/gynecology provider from any network clinic, in addition to her own PCC, without a referral W W W. M H P 4 L I F E. O R G 21