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Providers & Partners
Eligible persons enrolled in IMCare choose their primary care physician, pharmacy, mental health provider, and chiropractor, and have access to their choice of network dental and vision providers.
The network of primary care providers for IMCare includes:
IMCare works closely with Itasca County Public Health and Social Services to coordinate enrollee medical, social and community needs.
The network of primary care providers for IMCare includes:
- All of the primary care clinics in Itasca County and clinics in Hibbing and Cook
- Three hospitals in Itasca County and the hospital in Hibbing
- All Itasca County pharmacies and three pharmacies in Hibbing
- All chemical dependency providers in Itasca County
- Most of the Itasca County dentists, mental health providers, vision providers, and chiropractors
IMCare works closely with Itasca County Public Health and Social Services to coordinate enrollee medical, social and community needs.
Providers & Partners Forms
- Authorization Request (PDF)
- B vs D Determination Request (PDF)
- Case Management Referral Form (PDF)
- Chiropractic Authorization Form (DHS-4878-ENG) (PDF)
- DME Request Form (PDF)
- Home Care Request (PDF)
- IMCare Nursing Facility Private Room (PDF)
- IMCare Special Transportation (PDF)
- Medicaid Formulary Hep C Med Provider-Member Attestation Form 1-1-17 (PDF)
- Medical Referral for MRRP Enrollees (PDF)
- Medication Override Request Form (PDF)
- Medication Prior Authorization Form (PDF)
- Mental Health Authorization (FILLABLE FORM/ PDF)
- Minnesota Uniform Initial Credentialing Application (PDF)
- Minnesota Uniform Practitioner Change Form (PDF)
- Minnesota Uniform Reappointment Credentialing Application (PDF)
- Nursing Facility (NF) Communication Form (PDF)
- Ownership and Control Interest Disclosure Statement (PDF)
- Provider Appeal Form (PDF)
- Provider Clinic Grievance Reporting Form (PDF)
- Quality Improvement Organization Appeal Rights (PDF)
- Uniform Application Form for Initial Credentialing_DENTAL FILLABLE (PDF)
- Uniform Cover Sheet for Health Care Claim Attachments (PDF)