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Network Engagement Hot Topics

Health care is a dynamic industry and Wellmark is an equally dynamic company. To keep you updated on the most important changes that affect you, please check this page regularly.

 

Hot topics for July include:

 

Check out the updated Utilization Management (UM) tool user guides
Good news! Wellmark has streamlined the user guides for the UM Tool. The inpatient, procedures and durable medical equipment (DME); and out of network request UM tool user guides have recently received a facelift to make it easier for you to understand how to submit a pre-service review. Each guide was reviewed to determine the flow of content and the language used to describe the steps to complete a request. As a result, the three guides are shorter and include a new, interactive table of contents to help you get to the information you need faster. Check out the updated user guides by logging on to the secure Provider portal of Wellmark.com, today!

 

Thousands have already registered for WINS. Are you missing out?
Are you getting messages from the Wellmark Information Notification System (WINS)? Since the provider notification system began last year, thousands have registered to receive real-time updates from Wellmark delivered directly into their mailbox. With 11 different categories of information available, staying current on policies, processes and provider news has never been easier. To begin receiving messages, provide us with a few details, including your preferred email address, and then subscribe to the message categories you’re most interested in. Register today!
 
Transitional Care Management codes no longer covered
Effective for dates of service on or after July 1, 2015, Wellmark will no longer pay for Transitional Care Management codes 99495 and 99496. These codes are considered integral components of the overall care provided to members. Therefore, these services will not be eligible for separate reimbursement and will deny as bundled services. For more information, refer to the General Medical Provider Guide.
 
Learn more on how Wellmark coordinates benefits
Join us July 8, 2015, for the “Navigating Coordination of Benefits Claims” webinar. In this webinar we will help you understand Wellmark’s coordination of benefits (COB) policy, as well as provide you with instructions on filing COB claims and how secondary payment is determined. To learn more, register today!

 

2015 McKesson InterQual® clinical revisions
Wellmark is publishing the 2015 annual changes to the InterQual® criteria for providers to review prior to implementation. InterQual® criteria, published by McKesson Health Solutions, is used in many of Wellmark’s medical review processes to support the medical necessity of health care services. The effective date for the new criteria will be communicated closer to the implementation date. For more information and to view the changes, visit the InterQual® Criteria page on Wellmark.com.



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