Follow these steps to request a contract.
Contract process
Please note that reviewing a contract request does not guarantee that you will be offered a contract.
To have a contract application reviewed, please complete the following steps:
Step 1: Complete a Contract Request Form
- For Provider Specialty, write in “Housing Consultation/Care Coordination” or “Housing Transition/Sustaining”
- If you are providing both services, two separate contract requests must be submitted: One for Housing Consultation and one for Housing Transition/Sustaining
Step 2: Save and email the form along with a copy of your DHS Enrollment Letter 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 Housing Stabilization Services contract requests typically takes 60 days to complete.
Contract process
Please note that reviewing a contract request does not guarantee that you will be offered a contract.
To have a contract request reviewed, please complete the following steps:
Step 1: Complete a Contract Request Form
For the Provider Specialty, write in “Interpreter”.
Step 2: Complete the Interpreter Agency Information Update Form.
Step 3: 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 Interpreter contract requests typically takes 60 days to complete.
Contract process
Please note that reviewing a contract request does not guarantee that you will be offered a contract.
To have a contract request reviewed, please complete the following steps:
Step 1: Complete a Contract Request Form
For the Provider Specialty, write in “Personal Care Agency (PCA)”.
Step 2: Complete a PCA Information Form
Step 3: Gather the following proof of insurance:
- Commercial General Liability $1M per occurrence / $3M in aggregate
- Professional Liability coverage of $1M / $3M in aggregate
- Worker’s compensation insurance of $500,000
- Fidelity Bond of $20,000
- Surety Bond of $50,000
Name “Blue Cross Blue Shield of Minnesota” as a certificate holder on the document.
Step 4: Complete an Individual PCA Data Sheet
Step 5: 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 PCA contract requests typically takes 60 days to complete.
Please complete a contract request form.
When requesting a contract or new location, please submit the MN Uniform Practitioner Change form for each practitioner (required).
How to submit form:
Email to: provider.enrollment.and.credentialing@bluecrossmn.com
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 Blue Cross Credentialing team will notify you if credentialing is required.
Contract process
Please note that reviewing a contract request does not guarantee that you will be offered a contract.
To have a contract request reviewed, please complete the following steps:
Step 1: Complete a separate Contract Request Form for each type of transportation service your business provides.
For the Provider Specialty on the contract request form, write in one of the following as applicable:
- Special Transportation Services (STS)
- Common Carrier
- Common Carrier - Volunteer Drivers
Step 2: Complete the Provider Information Form
Step 3: Gather and/or complete these forms and information:
- Copy of STS MNDOT Vehicle Certificate for each vehicle (only required for STS)
- Copy of certificate of registration with the Office of the Secretary of State of Minnesota
- Copy of Driver Roster (XLS) (not required for volunteer drivers)
- Proof your employees and drivers have completed and passed the Net Study background check
- Proof of insurance – Send a copy of the Acord Certificate of Liability Insurance (not required for volunteer drivers)
- Blue Cross requires $1 million in auto liability in the combine single limit (each accident) auto insurance liability coverage.
- Name “Blue Cross Blue Shield of Minnesota” as a certificate holder on the document.
Step 4: 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 Transportation contract requests typically takes 60 days to complete.