Credentialing Information by State

Minnesota

If you are a Minnesota-based provider there are two ways to pursue credentialing.

Apply Through the Minnesota Credentialing Collaborative

If you are currently registered with the Minnesota Credentialing Collaborative (MCC), you can submit your Medica credentialing application via the MCC website. 

Apply Using the MN Uniform Credentialing Application

1. Download and complete the MN Uniform Initial Credentialing Application (PDF)
   Note: Please include an official copy of DEA certificate with application.
2. Download and complete Authorization and Release Form (PDF)
3. Email both documents to [email protected]

Note: Credentialing applications submitted to Medica must also include and Authorization and Release Form naming "Medica" or "Medica Health Plans" as the entity.

All Other States

If you are a provider based outside of Minnesota there are four ways to submit your credentialing application.

Apply Using Your State Specific Credentialing Application

1. Download and complete your state specific credentialing application
2. Download and complete the Authorization and Release Form (PDF)
3. Email both documents to Medica at [email protected]

Apply using CAQH (Council for Affordable Quality Healthcare®) Web-Based Tool

Visit the CAQH website to complete your application. Upon completing your application send the following information to [email protected]:

• Subject line to indicate initial or recredentialing application
• Name
• CAQH ID
• NPI
• State

Apply Using the Minnesota Credentialing Collaborative Web-Based Tool

If you have not enrolled, please visit www.mncred.org, or contact MCC [email protected] with questions.

Apply Using the Minnesota Uniform Credentialing Application

1. Download and complete the MN Uniform Initial Credentialing Application (PDF)
2. Download and complete Authorization and Release Form (PDF)
3. Email both documents to [email protected]

Note: Credentialing applications submitted to Medica must also include an Authorization and Release Form naming "Medica" or "Medica Health Plans" as the entity.

REV 12/2021