Contact Us
Plans and Services Health and Wellness About Wellmark Member Employer Broker Provider
Home » About Wellmark » Privacy and Legal » HIPAA-AS » For Providers
» Promises MatterTM
» Careers
» Community
» Company Information
» Contact Us
» Health Care Reform
» Newsroom
» Privacy and Legal
» Public Policy
 
HIPAA-AS For Providers

Use this section to find information for health care practitioners and facilities:

    
Format 835: Electronic Remittance Advice  Format 837: Health Care Claims
    
  

Quick Links

Authorization to Use or Disclose Protected Health Information
»   Individual Authorization - Iowa - #S-53258 pdf image
»   Individual Authorization - South Dakota - #S-3315 pdf image
»   Designation of Authorized Representative - Iowa
- #S-53257 pdf image
»   Designation of Authorized Representative - South Dakota - #S-3316 pdf image
Authorized Representative Appointment and Authorization for Release of Information
»   Iowa - #C-5674 pdf image
»   South Dakota - #C-3617 pdf image

See Also

»   Electronic Transaction & HIPAA Guides
»   Electronic Transaction Registration Packet
- #S-53260 pdf image (563KB)
»   Submitting Electronic Claims
»   Testing Toolkit pdf image (199KB)
Like Us facebook      Follow Us twitter      Watch Us youtube      Get Mobile App Download the Wellmark mobile app
 

 

© Wellmark, Inc. All Rights Reserved.
Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota.
 
Privacy & Legal  |  Browser Information