Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Credentialing

Non-Contracted Providers

Non-Contracted Providers must apply and be approved for network participation with South Country Health Alliance before practitioners can complete the Credentialing Process. To complete the contract application process for South Country, click on Providers > Forms > Non-Contracted Providers, and complete the Provider Contract Application > Web Form.

Credentialing Process

Please note that submitting a credentialing application is NOT a contract for provider participation. If you or your organization are not contracted with South Country, please see the Non-Contracted Providers section above for instructions to apply for a contract.

Requirements for Timely Provider Credentialing (MN State Statute 62Q.097)
MN law establishes specific standards that South Country follows to ensure practitioner credentialing is completed promptly and fairly.

What is a “Clean Application”?

A clean application is one that is complete and submitted in the required format, includes all requested information and supporting documentation, and does not require investigation or potential quality or safety concerns.

Credentialing Timeframes

South Country will complete the following process to ensure credentialing is completed timely:

  • Confirm Clean Application Status – if requested, notify the practitioner or credentialing personnel whether the submitted application is considered clean and share the date by which a credentialing decision will be made.
  • Request Missing Information Quickly – if the application is not clean, notify the practitioner or credentialing personnel of any deficiencies within 3 business days of identifying them.
  • Make a Timely Credentialing Decision – issue a credentialing determination within 45 days of receiving a clean application. If a substantive quality or safety concern is identified, South Country may take up to an additional 30 days to complete further investigation.

Prohibited Questions

South Country will not require practitioners to disclose past health conditions, current health conditions if they are being treated and does not affect the practitioner’s ability to practice, or any health conditions that would not impact their ability to practice in a competent, safe, and ethical manner.

Initial and Reappointment Application Submission Requirements
South Country requires all Initial and Re-Credentialing Applications to be completed and submitted using the Minnesota Credentialing Collaborative (MCC) web portal.

To access the MCC web portal - Minnesota Credentialing Collaborative (credentialsmart.net) (external link).

For assistance in setting up your MCC account, user guidance, and additional questions, please contact MCC Customer Support - 847-425-4616.

 Credentialing Forms

Credentialing Tips for More Efficient Application Processing

  • Credentialing applications should be submitted at least 90 days prior to the practitioner’s start date with the contracted organization. *South Country does not assign retroactive effective dates.
  • Complete credentialing applications in their entirety as incomplete applications delay the credentialing process.
  • Include an email address to receive important communications from South Country.
  • Include additional languages you fluently speak.
  • Completing Race/Ethnicity questions is highly encouraged to better serve South Country’s diverse population membership.
  • Include effective start dates, whether you’re accepting new patients, and if you’d like to be suppressed from South Country’s provider directories for each practice location.
  • State the specialty you currently provide to South Country members in the Primary Specialty field. If also providing a secondary/tertiary specialty, please state in the Subspecialty field.
  • All date fields must be in month, day and year format.
  • Explain employment gaps that exceed 3 months.
  • If there are no hospital admitting privileges, please describe coverage for continuity of care.
  • Professional references must have personal knowledge of your current (within past 12 months) clinical skills, abilities, judgment, professional performance, and clinical competence or have been responsible for professional observation or your work (limit to 1 current office associate). Do not include your residency or fellowship director, relatives or pending partners. At least 1 reference should be in your specialty/subspecialty.
  • Enter an affirmative response and detailed explanation to all applicable Disclosure Questions.
  • Updating the Attestation Update signature/date does not update the Authorization Release or Application Validation Statements. You must also update these application pages with your signature/date.
  • Include current copies of applicable professional state licensure, DEA registration and malpractice liability insurance certificate.

Rights and Notification

  • Practitioners shall have the right, upon written request, to review their credentialing file except for information that is privileged or protected from such disclosure and to submit corrective statements with respect to the initial application. South Country Health Alliance or its Third Party Administrator (TPA) will place the corrective statement in the practitioner's credentialing file, but this does not require South Country Health Alliance or its TPA to alter or delete any information contained in the file.
  • Practitioners shall be informed of any information discrepancies and shall have the opportunity to correct erroneous information gathered during the credentialing
    process, prior to review by the South Country Health Alliance Credentialing Committee.
  • Practitioners, upon request, shall be informed of the status of their credentialing or recredentialing application.

Credentialing Contacts

General Credentialing Email: credentialing@mnscha.org

Credentialing Supervisor: Jeanette Horn - jhorn@mnscha.org

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