Submitting Electronic Claims
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.
Electronic Transaction Registration
Register to securely submit electronic claims to Wellmark:
- Registration Instructions and Forms
- Electronic Transaction Registration Form for the following transactions:
- Signature and Audit Agreement
- Provider Authorization for Electronic Transactions Via Third Party
- Submitter Change of Address Request Form
- Cancellation Request
- Forms for 835 and EFT:
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:
- Wellmark examines claims for errors that will stop or delay the adjudication of claims.
- Wellmark produces two reports containing details about claims that were either accepted or rejected by Wellmark. The TXN (Transaction Summary) report, which includes HIPAA and eligibility verification information, is available within four hours of submission and the Z16 (Wellmark Acceptance) report with specific Wellmark editing information is available the next business date. Please note, the ACA compliant plans (those ID numbers with a W after the three letter prefix, e.g. XQGW00000000) will not be reported back on the Z16 report at this time.
- Once claims show as 'accepted' on the Z16 report, the claim status can be checked using the Check a Claim tool on Wellmark.com