According to MN Rules 4685.1110 and 4685.1900, providers are required to report verbal and/or written complaints which originate at the provider level to the member’s health plan. Quality of care and service complaints directed to the medical group will be investigated and resolved by the medical group.

This form is to be completed and sent or faxed to:

Hennepin Health/Grievance Department, Attn: Nekeita Adams

400 South 4th Street, Suite 201, Minneapolis, MN 55415

FAX 612-632-8815