Non-participating providers must apply for network participation by completing the 2322 Provider Contract Application (doc). The South Country Health Alliance Provider Network Department will review your application and respond with a determination.
Please note that submitting a credentialing application is NOT a contract for provider participation.
South Country Health Alliance is partnered with the Minnesota Credentialing Collaborative (MCC) and ApplySmart in order to offer providers a streamlined option for submitting credentialing applications. By enrolling with MCC, providers can access and use a centralized, Web-based clearinghouse for information used for 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 www.mncred.org for more information.
South Country encourages practitioners to complete the credentialing process using the MCC/ApplySmart system. If this is not an option, applications may be submitted via email to email@example.com. Faxed and hard copy submissions will be returned unprocessed.
Credentialing Tips for More Efficient Application Processing
- Credentialing applications should be submitted at least 90 days prior to the practitioner’s start date with your organization.
- All applicable sections of the credentialing application must be completed.
- All dates must be in month/year format.
- Credentialing applications must list employment history since education completion; gaps of 3+ months must be explained.
- Current copies of the practitioner’s professional state license, DEA registration (if applicable), and certificate of malpractice liability insurance are required with the application.
- Credentialing application pages that require a signature must be signed within 30 days of application submission.
Rights and Notification
- Practitioners shall have the right, upon written request, to review their credentialing file except for information that is privileged or protected from such disclosure and to submit corrective statements with respect to the initial application. South Country Health Alliance or its TPA will place the corrective statement in the practitioner’s credentialing file, but this does not require South Country Health Alliance or its TPA to alter or delete any information contained in the file.
- Practitioners shall be informed of any information discrepancies and shall have the opportunity to correct erroneous information gathered during the credentialing process, prior to review by the South Country Health Alliance Credentialing Committee.
- Practitioners, upon request, shall be informed of the status of their credentialing or recredentialing application.
- MN Uniform Credentialing Application – Initial (pdf)
- MN Uniform Credentialing Application – Recred (doc)
- MN Uniform Practitioner Change Form (doc)
- 2323 Organizational Credentialing Assessment Form (pdf)
Application and change form submissions: firstname.lastname@example.org
Credentialing questions/concerns/application status updates: email@example.com