Certified Registered Nurse Anesthetist Enrollment Criteria and Forms

Revised: October 19, 2023

To enroll as a certified registered nurse anesthetist (CRNA) with Minnesota Health Care Programs (MHCP), a CRNA must be an advanced practice nurse (APRN) and meet the following:

· Graduated within the past six months from a nurse anesthesia program approved by the National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA)

· Licensed as an APRN in state of practice

CRNAs may enroll with MHCP as individuals or groups.

How to Enroll

Providers who wish to enroll with MHCP can do so in one of the following two ways:

Online MPSE Portal

Register to access the Minnesota Provider Screening and Enrollment portal by using the instructions in the Registration and Access section in the MPSE Enrollment Manual. Complete your enrollment online using the MPSE portal. If enrolling through the MPSE portal, you will be required to upload a:

· Copy of current APRN license from state of practice

· Proof of CRNA certification

· Completed, signed and initialed copy of the Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

or

Submit Forms via Fax

Complete the following documents and fax your materials to 651-431-7462.

· Individual CRNA - Must complete and submit the following documents:

· Individual Provider Enrollment Application (DHS-4016) (PDF)

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Copy of APRN license from state of practice

· Proof of CRNA certification

· CRNA Group - Must complete and submit the following forms:

· Organization - Provider Enrollment Application (DHS-4016A) (PDF)

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF)

Review and keep a copy of the MHCP Data Privacy Notice (DHS-6287) (PDF).

We process forms in order of date received. Whether enrolling using the MPSE portal or by fax, allow 30 days for processing. If we need more information to complete your enrollment, we will send a request for more information letter via the U.S. Postal Service (or in your MN–ITS mailbox, if you have an account) telling you what you need to do to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services final federal provider screening regulations.

Refer to Revalidation in the Provider Screening Requirements section of the MHCP Provider Manual for more information about how to complete your revalidation.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in the Enrollment with MHCP section of the MHCP Provider Manual for details.

Legal References

Minnesota Statutes, 148.171, subdivision 21 (Definitions; Registered nurse anesthetist practice)
Minnesota Rules, 6305.0300, subpart 1 (Authorization to Practice Nursing; Required authorization)
Code of Federal Regulations, title 42, section 440.60 (Medical or other remedial care provided by licensed practitioners)