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 Delta Dental)
• DDS-Medical Dentist
• DC Doctor of Chiropractic (delegated to Fulcrum)
• 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 (MN only)
• LCSW Licensed Clinical Social Worker (WI and ND only)
• LICSW Licensed Independent Clinical Social Worker (MN only)
• LISW Licensed Independent Social Worker (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

Note: Residents: Moonlighting only require credentialing.

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

• AuD Audiologist
• AAAE Association for Anesthesiologist Assistant Education
• ADT Advanced Dental Therapist (MN only)
• CMHRP Certified Mental Health Rehabilitation Professional
• CRNA Certified Registered Nurse Anesthetist
• DT Dental Therapist (MN only)
• EIDBI/BCBAs Non Licensed Behavioral Technicians/Analysts (Level I, II or III - 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)
• RD Registered Dietician
• 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/Nursing Home

MENTAL HEALTH AND SUBSTANCE USE DISORDER

• Ambulatory Setting
• Inpatient
• Residential Facilities