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Mailing Address:  
Fairview Energy Park
Fairview System Credentialing Office
2344 Energy Park Dr Ste 127
St. Paul, MN 55108
 
General Office
Phone:
612-672-7700
Fax: 612-672-4244
Email: fsco@fairview.org
  

How To Submit An Application to the Fairview System Credentialing Office

UPDATE APPLICATIONS FOR CURRENT PRACTITIONERS: 
If you are currently a practitioner on staff at a Fairview entity and would like to apply to another Fairview entity, please contact  the Fairview System Credentialing Office by e-mail FSCO@fairview.org or by phone at 612-672-7700 to request an Update Application.

ADDITIONAL PRIVILEGES FOR CURRENT PRACTITIONERS:
If you are currently a practitioner on staff at a Fairview entity(ies) and would like to request additional privileges for that entity(ies),  follow the instructions listed below.  If you have any questions, contact the Fairview System Credentialing Office at 612-672-7700, option 1.

  • Complete the Additional Privileges Request Packet.
  • Select, print and complete the appropriate privilege form(s) Click here.
  • Mail the Additional Privileges Request Form and privilege forms(s) to:
    Fairview System Credentialing Office
    2344 Energy Park Dr. Ste. 127

       St. Paul, MN 55108
                    or
        Email to fsco@fairview.org
                   or
        Fax: 612- 672-4123

NEW FAIRVIEW APPLICANTS
:

1) Electronic Application Submission:
Click here to complete the application request form. An electronic application and privilege form(s) will be emailed directly to the email address you provide on the form. 

OR

2) Application Submission:  You may submit your application electronically to Fairview Health Services by following the instructions listed below:
  • Complete the form-fillable  Minnesota Uniform Credentialing Application, save as your own document and submit electronically or print and submit a paper copy.
  • Initial Credentialing Information Packet and Privileges Forms need to be printed, completed and submitted along with the application.     

 Note:  Privilege forms are not required if only applying to Fairview Physician Associates (FPA) and/or Behavioral Healthcare Providers (BHP)

Submit the completed credentialing application and privilege form(s) with all required supporting documentation to:

Fairview System Credentialing Office
Initial Applications
2344 Energy Park Dr. Ste. 127
St. Paul, MN 55108
 
              or

email to: SYSTEM-CREDENTIALING-INITIALS@fairview.org

 1. Initial Credentialing Information Packet

Included in this packet:

  • Initial Application Cover Letter
  • Credentialing Checklist
    The Credentialing Application Checklist is a valuable tool to assist in completing the credentialing application and to ensure you are submitting a complete application. Incomplete applications are returned to the practitioner or clinic and creates a substantial delay in the practitioner’s credentialing process.
  • Criminal Background Study Disclosure and Authorization Form
    Minnesota state law requires all health care practitioners complete a Criminal Background Study prior to participating in patient care activities. This form will authorize the Fairview System Credentialing Office to electronically submit a background study request to the Minnesota Department of Human Services. Our office cannot complete the credentialing verification process until the Criminal Background Study form is submitted and a response is received.
  • Fairview Authorization and Release
    Fairview has its own Authorization and Release form that must be completed in place of the Authorization and Release form included in the MN Uniform Credentialing Application. As part of its service to practitioners, Fairview System Credentialing Office provides delegated credentialing services to health plans and provider networks. When you apply to a Fairview entity, you accept certain conditions regarding immunities and authorizations to obtain or release information, including the release of information to these health plans and provider networks.
  • Immunization Documentation Form
    Complete the Immunization Documentation Form included in the packet and fax to the Employee Occupational Health Service number as listed on the form. 
  • Initial Application Flowchart
    This flow chart outlines the initial application process at Fairview.  In addition, contact names and phone numbers are listed if you have questions regarding your application.  
  • Application Fee Payment Form
    Initial applications require a fee of $200.  This form allows the option of payment via credit card or check. 

*Application fee for FPA only applications is $150.00

2.  Initial Credentialing Application Form


3.  Privilege Forms, click here.

 Contact Information for Initial Appointments Staff

 

Important information for all applicants: 
  • All credentialed practitioners are expected to read and be aware of the information contained in the following links:

Code of Professional Behavior
Notice of Accommodating Deaf or Hard of Hearing Patients

  • Practitioners who hold privileges at a Fairview facility are also responsible to read and be aware of the information contained in the Privileging Principles.

  • Proctoring of privileges may be requested if a practitioner does not meet the criteria, such as number of cases performed, as indicated on the privilege form. Proctoring requests must be approved in advance. Information on the process and forms are in the Proctoring Policy .

Initial privilege requests for moderate and/or deep sedation require the completion of a learning packet and test in the Sedation Learning Packet.

Required immunization information:
Immunization compliance is required for all practitioners prior to privileges being reviewed for approval at a Fairview facility. The immunization documentation form must be completed with  Initial or Reappointment applications, and faxed to Employee Occupational Health Services (EOHS) as listed on the form.


For questions about immunizations, see the Immunization FAQs, or call EOHS at 612-672-4602, or contact via email at  tlayon1@fairview.org
      

 

 
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