Credentialing for individual practitioners / clinics

Initial credentialing

Download and complete the Minnesota Uniform Initial Credentialing Application (PDF).

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

Blue Cross uses the credentialing process to evaluate each practitioner’s qualifications and performance. Upon receipt, the application will be reviewed for completeness and returned if incomplete. Providers may not schedule services with Blue Cross members until they have received written approval notification from Blue Cross and its affiliates.

Helpful tips

Your credentialing application should be submitted correctly and completely for it to be processed without delays. An incomplete application will not meet eligibility criteria for participation. Practitioner and Provider Participation requirements state that practitioners and providers respond in a timely manner to our courtesy requests for missing information or additional credentialing information.

The most frequently omitted items are:

  • Minnesota Medicaid Number (refer to the DHS – 4016 MHCP Provider Enrollment Application and Instructions)
  • Work history and education month and year (year alone is not complete)
  • Hospital privilege information
  • Authorization and release page with signature and current date
  • Copy of current malpractice insurance
  • Currently signed disclosure questions (with explanation to any questions answered with a “yes”)
  • Board Certification – Intent for certification scheduled date
  • Currently signed disclosure questions (with explanation to any questions answered with a “yes”)
  • Copy of current DEA for all locations where actively practicing

Your rights

  • To review information submitted to support your credentialing application
  • To correct erroneous information
  • To be informed of the status of the application upon request

Site visits

In some cases, a site visit will be required.

Recredentialing

Blue Cross uses the recredentialing process to re-evaluate each practitioner’s qualifications and performance. Practitioners are recredentialed at least every three years, but may be asked to recredential more frequently. The recredentialing process is initiated by the Blue Cross credentialing department based on the last credentialing or recredentialing approval date. A recredentialing profile that is populated with previous credentialing information is sent four (4) months prior to the recredentialing due date. All practitioners are expected to respond to the requests in a timely manner. Lack of timely return of the completed recredentialing profile may result in network termination.

Recredentialing may occur whenever Blue Cross deems appropriate (e.g., when there are quality of care concerns or when reasonable information has been identified by Blue Cross that a member may be endangered by potentially unsafe or unethical care or treatment).

Credentialing Committee / Decision

Credentialing applications are reviewed by the Medical Director and/or the Credentialing Committee on a regular basis. All credentialing decisions will be communicated in writing.

Credentialing Policy Manual

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. For more information on credentialing, please refer to the Credentialing Policy Manual (PDF).