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, please send an email to credentialing@primewest.org.

Please note that if your organization is not contracted with PrimeWest Health, submitting a credentialing application is NOT a request for a contract for provider participation. Review the Contracting section of the PrimeWest Health Provider Manual for more information on how to enroll as a PrimeWest Health-contracted provider.

Minnesota Health Care Programs (MHCP) Provider Enrollment Requirements

All practitioners wishing to credential with PrimeWest Health must be currently enrolled and active with MHCP. Screening and enrollment for MHCP is completed through the Minnesota Provider Screening and Enrollment (MPSE) portal.

Refer to Enrollment with Minnesota Health Care Programs (MHCP)> Eligible Providers in the Minnesota Department of Human Services (DHS) Provider Manual for a list of provider types that can enroll and instructions for how to enroll. Refer to the Minnesota Provider Screening and Enrollment (MPSE) portal training web page for training on how to use the MPSE portal to enroll. Refer to the Enrollment process for MCO network providers section of the DHS Enroll with Minnesota Health Care Programs web page for additional information. Contact the MHCP Provider Resource Center with any additional questions.
 

PrimeWest Health and the Minnesota Credentialing Collaborative (MCC)
PrimeWest Health providers can streamline the credentialing process by joining the Minnesota Credentialing Collaborative (MCC). MCC provides a centralized, web-based clearinghouse for information used in the credentialing process. The online product is an easy to use way to prepare, save, and send the credentialing application accepted by participating Minnesota health plans, hospitals, clinics, and practitioners. Visit the MCC website or read our handout to learn more.

Credentialing Forms
Use the forms below if you are a contracted provider with PrimeWest Health and you need to enroll a new practitioner. Forms must be downloaded before they can be completed and submitted. To download a form, right-click on the name of the form, choose “Save target as” or “Save link as,” select a folder on your computer, and click the “Save” button. After the form has finished downloading, navigate to the folder it was saved to and double-click it to open it in Adobe Reader. Failure to download the document prior to completing it will result in the document sending as a blank PDF without signatures.

• Minnesota Uniform Credentialing Application Initial: Physician/Allied Health Professional
  Providers should use this form to enroll a new practitioner.
   
• Minnesota Uniform Credentialing Application: Initial, Dentist
  Providers should use this form to enroll a new dental practitioner.
   
• Minnesota Uniform Credentialing Application Reappointment: Physician/Allied Health Professional
  Providers should use this form to recredential an existing practitioner. 
   
• Minnesota Uniform Credentialing Application: Reappointment, Dentist
  Providers should use this form to recredential an existing dental practitioner.  
   
• 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.
   
• Community First Services and Supports (CFSS) Application
  Submit this application if you are providing Community First Services and Supports (CFSS) to a PrimeWest Health member as a direct support worker.
   
• Personal Care Assistant (PCA) Application
  Submit this application if you are providing Personal Care Assistant (PCA) services to a PrimeWest Health member.
   
• Individual PCA/CFSS Information Change Form
  Use this form to notify PrimeWest Health when a PCA or CFSS provider leaves your organization or has a change to their demographic information.
   
• Pharmacist Initial Enrollment Application
  Providers should use this form to enroll a new pharmacist at a pharmacy providing Medication Therapy Management (MTM) services.
   
• Pharmacist Reappointment Enrollment Application
  Providers should use this form to recredential existing pharmacists at a pharmacy providing Medication Therapy Management (MTM) services. 

Credentialing References

• Credentialing Plan
• Credentialing Reference Guide
• CR16: Practitioner Rights

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Updated_09/23/2025