Get Mn Recredentialing Application

The Mn Recredentialing Application is a vital document for healthcare professionals seeking to renew their credentials. This guide provides clear and supportive instructions for completing the application online, ensuring that users can navigate the process with confidence.

Follow the steps to successfully fill out the Mn Recredentialing Application

1. Click ‘Get Form’ button to obtain the Mn Recredentialing Application in the online editor.
2. Begin by filling in your personal details, including your full name (last, first, middle), and any relevant suffixes. Make sure to include your title.
3. Enter your credentialing contact information, including your phone number, address, fax number, and email. If you are an allied health professional, be sure to fill in the specific section related to your profession and title.
4. Complete the personal data section accurately. This includes your maiden or former names, date of birth, NPI, social security number, Medicaid number, Medicare number, and current home address.
5. In the practice locations section, provide your primary and pending practice locations’ addresses, phone numbers, and federal tax ID number, ensuring accuracy for continuity of care.
6. Fill in the fellowship/post-graduate training details since your last reappointment, detailing program type, institution names, and completion status.
7. Document your professional and academic affiliations since your last reappointment, providing the name of institutions, positions held, and dates.
8. List your chronological employment or practice history, ensuring no gaps in chronology and including contact information for verification.
9. Provide required information about hospital affiliations, specialty certifications, state licensure, and documentation related to your drug enforcement registration.
10. Complete the disclosure questions, providing additional explanations where necessary. Focus on clarity and accuracy when detailing any employment or licensing issues.
11. Review the liability insurance section and ensure you enclose copies of your current coverage.
12. Read and sign the attestation to certify the truthfulness of all information. Finally, ensure that you've filled out all applicable sections and marked non-applicable areas with N/A.
13. Once completed, save your changes, and prepare to download, print, or share the Mn Recredentialing Application as needed.

Complete your Mn Recredentialing Application online today to streamline your credentialing process.