Administrative updates

If your question is not answered here, please call provider service at (651) 662- 5200 or 1-800-262-0820.

How to make updates

Add, remove or update Electronic Funds Transfer (EFT)

*Please note: All entities that share the same NPI must have the same EFT information.*

EFT can be added, removed or updated by completing the Provider Automatic Payment form (PDF). Include a copy of a cancelled check.

Fax to (651) 662-6684 or mail to:
Provider Contract Implementation, R317
PO Box 64560
St. Paul, MN 55164-0560

Add a clinic or branch

Complete a Contract Request form (PDF). Check the box “Add an Additional Location” and provide a list of the practitioners that will be providing service at the new location. If additional information is needed for a practitioner, you will be notified. A clinic site visit may be required. Please note: A request for a contract is not a guarantee that you will receive a contract.

The form and practitioner list should be faxed to (651) 662-6684 or mailed to:
Provider Data Operations, R316
PO Box 64560
St. Paul, MN 55164-0560

*Please allow up to 60 days for the completion of the branch addition process.*

If you are a facility that requires credentialing , please also submit an Facility Initial Provider Credentialing application (PDF) for each type and location. A facility site visit may be required.

Fax to (651) 662-2905 or mail to:
Provider Credentialing, R315
PO Box 64560
St. Paul, MN 55164-0560

*Please allow up to 60 days for the completion of the branch addition process.*

Add a location as result of a merger/buyout

Complete the Tax ID Change form (PDF), checking the appropriate box. A letter explaining the change in ownership or business structure will help ensure accurate changes to your data.

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

If you are a facility that requires credentialing , please submit a Facility Initial Credentialing application (PDF). A clinic site visit or facility site visit may be required.

Fax to (651) 662-2905 or mail to:
Provider Credentialing, R315
PO Box 64560
St. Paul, MN 55164-0560

*Please allow up to 90 days for completion of this process.*

Add a practitioner to your group

If the practitioner requires credentialing, submit a MN Uniform Credentialing application (PDF). Fax to (651) 662-2905 or mail to:
Provider Credentialing, R315
PO Box 64560
St. Paul, MN 55164-0560

If the practitioner’s credentialing is current or the practitioner doesn’t require credentialing, complete a Practitioner Addition and Termination form (PDF) or MN Uniform Practitioner Change form (PDF).

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

*Please allow up to 60 days for completion of the practitioner set up process.*

Add or remove an individual PCA or PCA supervisor to my group

Complete an Individual PCA Data Sheet (PDF).

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

*Please allow up to 60 days for completion of the practitioner set up process.*

Change tax ID

Complete the Tax ID Change form (PDF).

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

If you are a facility that requires credentialing , please also submit a Facility Initial Credentialing application (PDF). A clinic site visit or facility site visit may be required.

Fax to (651) 662-2905 or mail to:
Provider Credentialing, R315
PO Box 64560
St. Paul, MN 55164-0560

*Please allow up to 90 days for completion of the tax change process.*

Directory suppress a practitioner or remove a directory suppression

Complete a Practitioner Addition and Termination form (PDF) or MN Uniform Practitioner Change form (PDF). By checking “yes,” your name will not show up in our provider directories. You may also submit a letter explaining the changes you would like.

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

*Please allow up to 60 days for completion of this process.*

Remove a practitioner from your group

Complete a Practitioner Addition and Termination form (PDF) or MN Uniform Practitioner Change form (PDF).

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

*Please allow up to 60 days for the completion of the practitioner removal process.*

Report a clinic name change

Submit a letter explaining the changes, including the clinic NPI #, new legal business name, DBA name (if applicable) and effective date of change.

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

*Please allow up to 60 days for completion of the change process.*

Report a clinic or location closing

Complete a Provider Clinic/Branch Closure form (PDF). To ensure proper transition of care for impacted members, please provide at least a 60-day notice of a planned closure.

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

Please note that if your clinic is changing your tax ID as a result of a merger/buyout, please see the answer to the question: “Add a location as a result of a merger/buyout”.

Report a practitioner name change

Complete a MN Uniform Practitioner Change form (PDF) or submit a letter notification of the name change. If the practitioner’s name has not been changed on their license, please provide a copy of the official documentation of the name change.

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

*Please allow up to 60 days for completion of this process.*

Request to become a Behavioral Health or Chiropractic Select provider

**Please note: A request for a contract is not a guarantee that you will receive a contract. Also, you must have an Aware agreement in order to become a Select provider.**

Complete and submit a Contract Request form (PDF), checking the Request Type as “Select (BH or Chiro)” or submit a letter requesting a Select contract.

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

*Please allow up to 90 days for completion of this process.*

Request to become a Blue Plus provider (Referral or Primary Care Clinic)

**Please note: A request for a contract is not a guarantee that you will receive a contract. Also, you must hold an Aware agreement before you can request to become a Blue Plus provider.**

Submit a letter requesting to become a Blue Plus Referral or Primary Care Clinic Provider. If you would like to be an in-network provider for our service co-op groups (and you are a specialist provider), you should request a Blue Plus Referral agreement. A clinic site visit may be required.

Fax to (651)662-6684 or mail to:
Network Management, R317
PO Box 64560
St. Paul, MN 55164-0560

*Please allow up to 90 days for completion of this process*

Submit and receive electronic transactions (837/835)

To receive additional information on registering for electronic transactions, please visit the Availity website. ExternalLink

Update address or phone number

Complete the Provider Change form (PDF) and submit by fax to (651) 662-6684 or mail to:
Provider Data Operations, R316
PO Box 64560
St. Paul, MN 55164-0560

*Please allow up to 60 days for completion of the change process.*

Update NPI

An updated NPI can be submitted through Provider Web Self-Service or by completing a Provider Demographic Change form (PDF) for any contracting provider/facility or practitioner already set up on our system. (For new contracting providers/facilities or practitioners, the NPI should be entered on the initial request forms.)

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

*Please allow up to 60 days for completion of this process.*