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Submitting Electronic Claims

Electronic Transaction Registration 

Register to securely submit electronic claims to Wellmark:

Testing Your System

EC Solutions receives claims data for Wellmark. Call EC Solutions at 1-800-407-0267 to submit a test claim so you can determine if your system is set up to submit NPI-only claims.

 

What Happens After You Submit a Claim

Once you submit a claim to Wellmark:

  1. Wellmark separates claims by payers and examines them for errors that might stop or delay the adjudication of claims.
  2. Wellmark sends a secure e-mail to let you know the transmission was successful.
  3. Within six hours of submission, you can download a transaction report with details about claim acceptance or rejection.

Commercial claims are sent to a clearinghouse for distribution to other payers.

 

Rules Governing Electronic Transactions

The administrative simplification part of the Health Insurance Portability and Accountability Act (HIPAA) governs the electronic processing of health insurance claims. View the Electronic Transaction and HIPAA Guides to get answers to your electronic transaction questions so you can be HIPAA-compliant. Note: Read more about the Federal regulation that mandated the transaction standard version 4010A1 be replaced with the new version 5010 effective January 1, 2012.



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