Join our network

Requesting a contract

A request for a contract is not a guarantee that you will receive a contract. All contract requests are reviewed for adequate member access to in-network care.

The contract and credentialing process takes approximately 90 days to complete. Providers cannot schedule services with Blue Cross members until they have received written approval notification from Blue Cross and its affiliates. Any claims submitted prior to this will be processed as out of network.

Before starting the application process, determine if you are located in our contracting area.

Process

1. Determine if credentialing is required.

If credentialing is required, complete one of the following applications:

Individual practitioner (one per practitioner) (PDF)
Facility (one per location/one per provider type) (MS Word)

Fax to (651) 662-2905, or mail to:
Blue Cross and Blue Shield of Minnesota
Credentialing Department R315
P.O. Box 64560
St. Paul, MN 55164-0560

If credentialing is not required, complete one of the following forms for each practitioner (if applicable):

Practitioner Addition and Termination form (PDF)
Minnesota Uniform Practitioner Change form (PDF)

Fax to (651) 662-6684, or mail to:
Provider Data Operations, R316
P.O. Box 64560
St. Paul, MN 55164-0560

2. Complete a contract request form (PDF) and submit with the above forms. A clinic site visit or facility site visit may be required.

Fax the form to (651) 662-6684, or mail it to:
Provider Data Operations, R316
P.O. Box 64560
St. Paul, MN 55164-0560

Please note that submission of a contract request form is not a guarantee that you will receive a contract. Our network composition is regularly reviewed to ensure adequate access and availability for our members. The reviewed specialties list is a list of specialties that we identified adequate access to in MOST areas. Even if you are requesting to be participating as a specialty on the list, we still encourage you to apply as the composition of our network changes regularly.

Questions?

Please call provider service at (651) 662- 5200 or 1-800-262-0820.

Contracting area

Our primary provider contracting area is Minnesota and the border counties of North Dakota, South Dakota, Iowa and Wisconsin (see list below). Please note that we do contract with Lab, DME and Pharmacy providers outside of this service area.

If you are not located in one of these counties and are not a lab, DME, or pharmacy provider, please complete and submit a Non Participating Setup Request form (PDF).

List of states and counties

Iowa

• Allamakee
  
• Dickinson
  
• Emmet
  
• Howard
  
• Kossuth
  
• Lyon
  
• Mitchell
  
• Osceola
  
• Winnebago
  
• Winneshiek
  
• Worth

North Dakota

• Cass
  
• Grand Forks
  
• Pembina
  
• Richland
  
• Traill
  
• Walsh

South Dakota

• Brookings
  
• Deuel
  
• Grant
  
• Minnehaha
  
• Moody
  
• Roberts

Wisconsin

• Buffalo
  
• Burnett
  
• Douglas
  
• La Crosse
  
• Pepin
  
• Pierce
  
• Polk
  
• Saint Croix
  
• Trempealeau
  
• Vernon

Reviewed specialties

We have determined that there is sufficient member access for the following list of provider specialties in most of our service area. New contracts for these provider specialties will be offered on an exception basis only.

If a provider is denied a contract with Blue Cross, a letter will be sent informing the provider of the denial. The letter will also outline the process for appealing the denial. If appealing the denial, new information must be sent that was not included in the original application, including an explanation why an exception should be made, otherwise the appeal request will not be considered.

Allied providers

• Acupuncture
  
• Ambulance
  
• Audiologists
  
• Certified Labs
  
• Chiropractors
  
• Common Carrier
  
• DME
  
• Hearing Aides
  
• Home Health
  
• Home Infusion
  
• Interpreter
  
• Occupational Therapy
  
• Opticians
  
• Optometry
  
• OP Physical Rehab Facility
  
• PCA/PCPO
  
• Pharmacy
  
• Physical Therapy
  
• Sleep Centers & Labs
  
• Special Transportation Services
  
• Speech Therapy
  
• Retail Clinic

Mental health and substance abuse

• ACT/ARMHS
  
• Adolescent Substance Abuse (Rule 2960)
  
• Adult Substance Abuse
  
• Behavioral Health Clinic
  
• Behavioral Therapist Practitioner (Autism)
  
• Community Mental Health Clinic
  
• Crisis Lodging
  
• IRTS
  
• LICSW
  
• LMFT
  
• LPC
  
• LPCC
  
• Mobile Crisis
  
• Opioid Clinics
  
• Psychologist, MA Level Only
  
• Residential Treatment
  
• RNCS
  
• Rule 25 Assessors
  
• Rule 29 Clinic

Is credentialing required?

Refer to the lists below to learn if you or your facility needs to go through the credentialing process before you may join the Blue Cross network.

About credentialing

Blue Cross and Blue Shield of Minnesota uses a credentialing process to provide members with a selection of physicians and other healthcare professionals who have demonstrated backgrounds consistent with the delivery of high quality, cost-effective health care. We have established credentialing criteria for network participation that is used to evaluate a provider’s credentials. The credentialing criteria serve as the foundation for determining a provider’s eligibility and continued eligibility in all Blue Cross networks. Providers are expected to remain in compliance with credentialing criteria at all times.

Refer to the Credentialing Policy Manual (PDF) for complete information.

Facilities that require credentialing

Medical Specialties:

• Ambulatory Surgery Center (Free-standing Only)
• Home Health Care Agency
  
• Hospital (All Types, including Psychiatric)
  
• Skilled Nursing Facility / Nursing Home
  
• Sleep Center (Free-standing Only)
  
•  
• Behavioral Health Specialties:
• Adult Foster Care Licensed Residential Care
  
• Child Foster Care / Residential Mental Health (MN DHS Rule 2960)
  
• Mental Health Day Treatment or Partial Psych / Partial Hospitalization
  
• Mental Health Residential / Inpatient, IRTS, Residential Crisis (MN DHS Rule 36)
  
• Opioid / Methadone Clinic
  
• Adolescent Substance Abuse (MN DHS Rule 2960)
  
• Adult / Adolescent Substance Abuse (MN DHS Rule 31)
  

More about facility credentialing

Practitioner types/specialties that require credentialing

• Physician (MD, DO)
  
• Podiatrist (DPM)
  
• Chiropractors (DC)
  
• Optometrists (OD)
  
• Oral & Maxillofacial Surgeons (MD)
  
• Psychologists (PhD, PSYD, Ed D, MA, MS)
  
• Licensed Acupuncturist (LAC)
  
• Licensed Clinical Social Worker (LCSW) (WI Only)
  
• Licensed Independent Clinical Social Worker (LICSW)
  
• Licensed Independent Social Worker (LISW) (IA Only)
  
• Licensed Mental Health Counselor (LMHC) (ND Only)
  
• Licensed Professional Clinical Counselor (LPCC)
  
• Licensed Professional Counselor (LPC) (Must be able to practice without supervision)
  
• Licensed Marriage and Family Therapist (LMFT)
  
• Certified Nurse Midwife (CNM)
  
• Registered Nurse Clinical Specialist (RNCS, CNS)
  
• Registered Nurse Practitioner (RNP)
  
• Physician Assistant (PA)

More about individual practitioner credentialing

Practitioner types/specialties that do not require credentialing

• Audiologist
  
• Certified Registered Nurse Anesthetist (CRNA)
  
• Dentist (DDS)
  
• Oral & Maxillofacial Surgery (DDS, DMD)
  
• Occupational Therapist (OT)
  
• Physical Therapist (PT)
  
• Registered Nurse First Assistant (RNFA)
  
• Registered Nurse supervising PCAs
  
• Residents (in approved residency training)
  
• Speech Language Pathologists (SLP)
  
• Hospital-based practitioners include pathologists, radiologists, anesthesiologists (unless practicing pain management), and emergency room physicians
  
• Personal Care Assistants (PCA)
  
• Mental Health Practitioner Supervising an ARMHS Program