Contracts and Credentialing with Health Plans - Minnesota Dept. of Health

Contracts and Credentialing with Health Plans

The purpose of a contract is to document the obligations and responsibilities of each health plan, individual practitioner and/or provider organization. After contracting with a health plan, a provider is considered in-network or a participating provider, and is eligible for reimbursement from the health plan at negotiated rates.

Credentialing is the process used to determine if an individual practitioner and/or provider organization is qualified and competent to deliver acceptable medical care. An individual practitioner and/or provider organization is credentialed when they apply for participation in an insurance network and every three years thereafter.

  • Medicare Enrollment for Providers and Suppliers
    Medicare providers can use the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to complete the enrollment process by securely submitting and managing Medicare enrollment information. PECOS can be used instead of the Medicare Participating Physician or Supplier Agreement (form CMS-460) and the Medicare enrollment application (form CMS-855). Learn more about the Medicare enrollment process under “Enrollment Tutorials.” Attention: Non-MDH link
  • BlueCross BlueShield Minnesota: Join Our Network
    Blue Cross and Blue Shield of Minnesota requires a contract to be considered a participating or in-network provider. A request for a contract does not guarantee that you will receive a contract. Any claims submitted prior to written approval notification from Blue Cross will be processed as out of network. Attention: Non-MDH links
  • Medica: Join Our Provider Network
    Medica requires a contract to be considered a participating or in-network provider. Providers may not submit claims for services provided to Medica patients for dates of service prior to the completion of their credentialing. Attention: Non-MDH link
  • Minnesota Credentialing Collaborative (MCC)
    Blue Cross and Blue Shield of Minnesota, HealthPartners, and Medica health plans are now using the Minnesota Credentialing Collaborative’s (MCC) ApplySmart system. Health care providers can join the MCC and use this web-based credentialing app to submit the credentialing application. Attention: Non-MDH link

Updated Thursday, October 08, 2015 at 01:13PM