If you are a behavioral health or substance use disorder provider, please complete the behavioral health contract request form (PDF).
Do not see Blue Cross members until you receive an executed (signed by Blue Cross) contract or amendment. Any claims submitted prior to that time will either be denied or processed as out of network.
About forms: To open or fill in PDF forms, you'll need Adobe Acrobat Reader. Having trouble opening PDFs? See tips from Adobe.
How many practitioners do you have?
Five or fewer practitioners: When requesting a contract, please submit the MN Uniform Practitioner Change form (PDF) for each practitioner.
Six or more practitioners: If six or more need to be affiliated with the new location or contract, please fill out the Multiple practitioner add sheet (xlsx).
Where to submit your form(s)
Save and email the 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
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 Credentialing team at Blue Cross will notify you if credentialing is required.