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Details on contracting, credentialing and recredentialing.
Details on contracting, credentialing and recredentialing.
Blue Cross continually assesses its network of providers to ensure that it is sufficient to meet the access and availability needs of its members throughout the service area in accordance with Minnesota Statute 62K.10.
Provider networks that sufficiently meet the access and availability needs of our members are "managed."
Managed networks = Contract requests are not being accepted at this time.
The Blue Cross provider contracting area includes Minnesota and the border counties of North Dakota, South Dakota, Iowa and Wisconsin. Lab, DME and pharmacy providers are an exception to this contracting area.
If you are not in one of these counties and are not a lab, DME or pharmacy provider and you need to submit a claim, contact your local Blue Cross plan.
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Providers that are eligible for a provider contract but are not required to have a contract are limited. Limited networks are accepting contract requests.
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Iowa | North Dakota | South Dakota | Wisconsin |
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Allamakee | Cass | Brookings | Buffalo |
Dickinson | Grand Forks | Deuel | Burnett |
Emmet | Pembina | Grant | Douglas |
Howard | Richland | Minnehaha | La Crosse |
Kossuth | Trail | Moody | Pepin |
Lyon | Walsh | Roberts | Pierce |
Mitchell | Polk | ||
Osceola | Saint Croix | ||
Winnebago | Trempealeau | ||
Winneshiek | Vernon | ||
Worth | Vernon |
Before a request for a contract can be considered, providers must enroll with Minnesota Health Care Programs (MHCP). MHCP is administered by the Minnesota Department of Human Services (DHS).
The following must be enrolled:
Enrolling with MHCP does not mean that providers must contract with MHCP, though providers may do this if they wish.
Do not submit a contract request form until you receive a MHCP Enrollment or Welcome Letter/Notification.
Instructions for enrolling with MHCP can be found on the DHS website (select “Enrollment process for Managed Care Organization (MCO) network providers”).
Any claims submitted prior to that time will either be denied or processed as out of network.
A request for a contract is not a guarantee that you will receive one.
The process for approved contract requests typically takes 60-90 days to complete. The timing is dependent on whether facility or practitioner credentialing by Blue Cross is needed. The Blue Cross Credentialing team will notify you if credentialing is required.
If you are a healthcare provider that is not listed above, complete a contract request form
Five or fewer practitioners: When requesting a contract or new location, submit the MN Uniform Practitioner Change form for each practitioner.
Six or more practitioners: If six or more need to be affiliated with the new location or contract, fill out the Multiple Practitioner Add Sheet (xlsx).
Behavioral health providers only:
All other providers:
Save and email form(s) to: provider.enrollment.and.credentialing@bluecrossmn.com
Or mail to:
Blue Cross and Blue Shield of Minnesota
Provider - PDO
PO Box 982809
El Paso, TX 79998-2809
Some specialties require credentialing. Contracted providers are expected to always remain in compliance with credentialing criteria. The credentialing team will notify you if credentialing is required.