Provider Forms

Note: PDF forms require Adobe Acrobat Reader.

If you are a provider wanting to appeal a claim determination, please click here.

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

Medical Management - Fax Forms to 763-847-4014

Provider Relations - Fax Forms to assigned Provider Relations Representative or 763-847-4010 Attn: Provider Relations