Get Mn Uniform Credentialing Application 2016
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How to fill out the MN Uniform Credentialing Application online
The MN Uniform Credentialing Application is an essential document for practitioners seeking reappointment in Minnesota. This guide will provide step-by-step instructions to help users complete the application online with ease and accuracy.
Follow the steps to complete your application effectively.
- Press the ‘Get Form’ button to access the MN Uniform Credentialing Application and open it for editing.
- Begin by entering your full applicant name as it appears on your state license, including your last name, first name, middle name, suffix, and title in the designated fields.
- Fill in your credentialing contact information, including your name, address, phone number, fax number, and e-mail address.
- If you are an allied health professional, complete the section that asks for your profession/title and the sponsoring or collaborative physician details.
- Provide your personal data, including any former aliases, date of birth, gender, social security number, NPI, and current home address.
- Specify your primary or pending practice location details. Include the clinic name, address, office phone number, fax number, federal tax ID number, type II NPI, and start date.
- Detail your training, including any fellowship or postgraduate trainings since your last reappointment. Include the institution name, program type, and expected completion dates.
- List your chronological employment or practice history, ensuring to cover all gaps, including military service, sabbaticals, or personal time away from practice.
- Complete the sections related to hospital affiliations and specialty certifications. Ensure all relevant dates and information are accurately reported.
- Review and answer all disclosure questions completely. For any affirmative responses, provide thorough explanations as necessary.
- Sign and date the attestation and authorization sections to confirm that all information provided is true and accurate.
- Finally, save the form. You can choose to download, print, or share the completed application as needed.
Complete your MN Uniform Credentialing Application online to ensure a smooth reappointment process.
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Credentialing focuses on verifying a provider's qualifications, while contracting involves establishing agreements between providers and health plans. Credentialing is the prerequisite to contracting, ensuring that only qualified individuals enter into these agreements. By using the MN Uniform Credentialing Application, you can efficiently manage both credentialing and contracting processes, paving the way for successful healthcare partnerships.
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