Provider Forms

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Code Auditing Request for Review form

Effective September 1, 2013 PreferredOne requires initial credentialing applications to be submitted using the MCC electronic Application as announced in the June 2013 Provider Newsletter.

Credentialing - Fax Forms to 763-847-4814 Attn: Credentialing

Coding - Fax Forms to 763-847-4957

Medical Management - Fax Forms to 763-847-4014

Provider Relations - Fax Forms to 763-847-4010 Attn: Provider Relations