Please note, there is scheduled maintenance Friday, February 3rd until Monday, February 6th. Some pages and features may not be available during this time.

Provider Forms

Note: PDF forms require Adobe Acrobat Reader.

If you are a provider wanting to appeal a claim determination, please click here.

Credentialing - Email: or Fax Forms to 763-847-4814

Medical Management - Fax Forms to 763-847-4014

Provider Relations - Fax Forms to assigned Provider Relations Representative or 763-847-4010 Attn: Provider Relations