Who requires credentialing

• LAc Acupuncturist
• CICSW Certified Independent Clinical Social Worker (WI only)
• CNM Certified Nurse Midwife
• CNP Certified Nurse Practitioner
• APNP Advanced Practice Nurse Prescriber (WI only)
• CNS Clinical Nurse Specialist
• CSW-PIP Certified Social Worker – Private Independent Practice (SD only)
• DDS-Dental Dentist (delegated to DentaQuest)
• DDS-Medical Dentist
• DC Doctor of Chiropractic (delegated to Optum Chiropractic Network)
• DMD Doctor of Medicine in Dentistry or Doctor of Dental Medicine
• DO Doctor of Osteopathy
• DPM Doctor of Podiatric Medicine
• LADC Licensed Alcohol and Drug Counselor (MN only and only when practice does not hold a facility license)
• LBA Licensed Behavior Analyst
• LCSW Licensed Clinical Social Worker (WI and ND only)
• LICSW Licensed Independent Clinical Social Worker (MN only)
• LISW Licensed Independent Social Worker (IA only)
• LMHC Licensed Mental Health Counselor (IA only)
• LMFT Licensed Marriage and Family Therapist
• LPC Licensed Professional Counselor (WI only)
• LPCC Licensed Professional Clinical Counselor
• LPC-MH Licensed Professional Counselor-Mental Health (SD only)
• LP Licensed Psychologist
• LTM Licensed Traditional Nurse Midwife (only providing services at birthing centers)
• OD Optometrist
• MD Physician
• PA Physician Assistant

Notes

Residents: Moonlighting only require credentialing.

Telehealth Practitioners should see the Telehealth requirements section of the Provider Manual.

Behavior Analysts see EIDBI Credentialing requirements section of the Provider Manual.

Locum tenens practitioners (all types) require credentialing.

• AuD Audiologist
• AAAE Association for Anesthesiologist Assistant Education
• ADT Advanced Dental Therapist (MN only)
• BCaBA Board Certified Assistant Behavior Analyst (EIDBI)
• CMHRP Certified Mental Health Rehabilitation Professional
• CRNA Certified Registered Nurse Anesthetist
• DT Dental Therapist (MN only)
• MD Doctor of Anesthesiology (pain management practicing in a clinic setting require credentialing)
• HB Hospital-based practitioners
• HP Hospitalist
• OT Occupational Therapist
• Path Pathologists
• PCA Personal Care Assistant
• PharmD Pharmacist (licensed for medication therapy management services only)
• PT Physical Therapist
• Rad Radiologists (radiation oncology practicing in a clinic setting require credentialing)
• RBT Registered Behavior Technician (EIDBI)
• RD Registered Dietitian
• SLP Speech Language Pathologists

• CADC Certified Alcohol and Drug Counselor
• CGC Certified Genetic Counselor
• COTA Certified Occupational Therapy Assistant
• CDP Chemical Dependency Professional
• LAMFT Licensed Associate Marriage and Family Therapist
• LGSW Licensed Graduate Social Worker
• OPA-C Orthopedic Physician Assistant
• PTA Physical Therapy Assistant
• RN Registered Nurse
• SA/SAC Surgical Assistant

MEDICAL

• Ambulatory Surgery Center – free standing only
• Birth Center – free standing only
• Home Health Care Agency - provides skilled nursing services (not a PCA-only agency)
• Hospital – all types including psychiatric
• Skilled Nursing Facility or Nursing Home

MENTAL HEALTH AND SUBSTANCE USE DISORDER

• Ambulatory Setting
• Inpatient
• Residential Facilities