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.

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) (PDF)

Fax to (651) 662-2905, or mail to:
Blue Cross and Blue Shield of Minnesota
Credentialing Department S115
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, S116
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, S116
P.O. Box 64560
St. Paul, MN 55164-0560

Questions?

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