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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.

Credentialing Policy Manual

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 information on 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 information on 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