Credentialing
Credentialing is required for certain provider types at participating facilities. Below, we have information and resources to help you with the process. If you need additional assistance, contact the Provider Contact Center and we will be happy to assist you.
PrimeWest Health and the Minnesota Credentialing Collaborative (MCC)
PrimeWest Health has joined the Minnesota Credentialing Collaborative (MCC) to offer our providers a streamlined option for submitting their credentialing applications to PrimeWest Health. By joining MCC, providers can access and use a centralized, web-based clearinghouse for information used in the credentialing process. The online product is an easy way to prepare, save, and send the credentialing application that is accepted by participating Minnesota health plans, hospitals, clinics, and practitioners. Visit the MCC website to learn more. Read more about the MCC.
Credentialing Forms
Use the forms below if you are a contracted provider with PrimeWest Health and you need to enroll a new practitioner.
- Minnesota Uniform Credentialing Application Initial: Physician/Allied Health Professional
Providers should use this form to enroll a new practitioner.
- Minnesota Uniform Credentialing Application (X14894): Initial, Dentist
Providers should use this form to enroll a new dentist.
- Minnesota Uniform Credentialing Application Reappointment: Physician/Allied Health Professional
Providers should use this form to enroll an existing practitioner.
- Minnesota Uniform Credentialing Application (X14894): Reappointment, Dentist
Providers should use this form to enroll an existing dentist.
- Minnesota Uniform Practitioner Change Form
Use this form to add, remove, or make a change to demographic data for credentialed practitioners or add specialists not subject to credentialing.
- Fitness Professional Credentialing Application Form
Providers should use this form to enroll a new fitness professional.
- Reappointment Credentialing Application for Fitness Professionals
Providers should use this form to recredential existing contracted fitness professionals.
- Personal Care Assistant (PCA) Application
Use to enroll a new Personal Care Assistant
- Individual PCA Information Change Form
Use this form to notify PrimeWest Health when a PCA leaves your organization or has a change to his/her last name
- Pharmacist Initial Enrollment Application
Use to enroll a new pharmacist at a Medication Therapy Management (MTM) services pharmacy
- Pharmacist Reappointment Enrollment Application
Providers should use this form to recredential existing contracted pharmacists at a Medication Therapy Management (MTM) services pharmacy
Credentialing References