Covered Services

All services billed to PrimeWest Health must be:

1. Provided by eligible, qualified providers performing services permitted by applicable Federal and State laws and rules
2. Within program service guidelines/limitations
3. Documented in the patient’s medical record

Under MN Stat. sec. 256B.0625, subd. 34, all covered services provided through IHS and Tribal facilities are paid by DHS or Medicare fee-for-service (FFS) with the following exception in which PrimeWest Health is billed as primary:

• Medicare-covered services provided to members in our Medicare Advantage programs (PrimeWest Senior Health Complete [HMO SNP] and Prime Health Complete [HMO SNP])

Please note that PrimeWest Health does not reimburse at the IHS or Tribal encounter rates.

PW_11-19_606
Updated_12/05/2024