Ructions are bolded in italics on the application Submit completed application along with all required documentation APPLICATION NOTES For the purposes of this application, "facility" is defined as a hospital; home health agency; skilled nursing facility; ambulatory surgery center; and inpatient, residential, and ambulatory behavior health facility As required by the facility contract and accrediting agencies, a completed application is required at the time of contracting and at l.
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How to fill out the MN UCare Uniform Facility Credentialing Application online
Completing the MN UCare Uniform Facility Credentialing Application online is an essential step for facilities seeking network participation. This guide provides detailed instructions to help users navigate the form effectively.
Follow the steps to successfully complete the application.
- Press the ‘Get Form’ button to access the application form and open it in your preferred online editor.
- Fill in all required fields in the corporate identification section, including legal business name, federal TIN/tax ID, and business address. Make sure the federal TIN is a valid 9-digit number.
- Complete the facility information section, providing the facility's DBA name, address, contact details, and mailing address if different.
- Identify the Medical Director or their equivalent and enter their contact information, ensuring they are licensed in good standing.
- Select the facility type by checking the appropriate boxes based on your license status and the services provided.
- Attach a copy of the facility's licenses within the licensure section. Note the licensing agency, effective date, and expiration date.
- Indicate the Medicare status of the facility by checking 'Yes' or 'No', and provide the Medicare number and date of initial certification if applicable.
- Complete the accreditation information, indicating the latest accreditation survey date and if your facility is currently accredited.
- If your facility is not accredited, describe the status of your licensing review and attach any required documentation.
- Fill out the insurance coverage information. Attach relevant certificates as specified in the application.
- Indicate the languages spoken by staff, including whether sign language or interpreter services are available.
- Complete the attestation section by signing and dating the application, confirming all information is accurate.
- Review all sections to ensure completeness, save changes, and download or print the completed application to submit via email to the appropriate Health Plan.
Begin completing your MN UCare Uniform Facility Credentialing Application online today.
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