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:
Register for the Wellmark Information Notification System (WINS) today
What is all this WINS craze? You may have heard people in your office recently talking about WINS, and that’s probably because they are already registered to receive real-time updates from Wellmark and you can too. To register, log in to the secure provider tab on Wellmark.com and then click, “Wellmark Information Notification System (WINS)” from the “Quick Links” sidebar on the right side of the page. Simply enter in your contact information, including your email; select your categories, and click ‘save’. For more information, visit the Real-time Updates page on Wellmark.com.
Avoid BlueCard confusion
Join us July 9, 2014 for a webinar to learn the basics about BlueCard and be more efficient. Throughout the webinar you can look forward to learning how to identify BlueCard members, filing claims, when to inquire, and much more. Register today to take part in this great education session!
Resubmitting incomplete claims
You may have received a letter recently detailing crucial information that is missing and/or needs correcting on claims in order to be processed. If you feel that the claims were submitted correctly and contained no errors, please submit new claims for those in question. Wellmark will not accept claims marked with corrections or attached to a Provider Inquiry form. For more information on claims denied for missing information, view the Claims Filing Provider Guide on Wellmark.com.
Hold the fax and attach documents online
If you haven’t heard, Wellmark has enhanced the Ask & Track a Question tool. Now documents can be uploaded directly to your web inquiry to help save you time. Simply log in to Wellmark.com to check out the improvements and start attaching documents to your inquiries today! To learn more about the tool, check out the three minute how-to video located on the Provider Video Gallery.
New provider change form now available
The provider change form has a new look to help save you time when updating business or facility information. Wellmark has combined the former practitioner payment authorization, organizational NPI change and back-up physician forms into the online provider change form. To access the new form and view the improvements, go to Wellmark.com.
New NCCI edits to bundle nursing visit
The National Correct Coding Initiative (CCI) version 20.1 was recently released and became effective April 1, 2014. It contains new edits which bundle CPT 99211 with venous blood draw (CPT 36415) and with EKG (CPT 93000, 93005, and 93010). This change will impact practices that have typically billed a nurse only visit in conjunction with lab work or an EKG. If there is a separate reason for the established patient visit for the EKG or blood draw, please use the appropriate modifier.
2014 McKesson InterQual® clinical revisions
Wellmark is publishing the 2014 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
Procedures requiring pre-service review
Determining if a procedure requires pre-service review can be difficult, but Wellmark’s Authorization Table is designed to help. Before planning a procedure, check out the Authorization Table to determine if pre-service review is necessary. Simply enter in the CPT, HCPC code, or keyword to search. If a service is not listed on the Authorization Table, Wellmark does not maintain a policy on the service or procedure- meaning no pre-service review is necessary. To learn more, visit the Medical Policies and Authorizations Web page on Wellmark.com.
Customer service number for Federal Employee Program (FEP) members
Members that have the alpha prefix beginning with the letter ‘R’ followed by eight digits are identified as FEP members. Wellmark has a separate customer service line dedicated to answer your questions. If you are needing to inquire about a FEP member’s claim or benefits, please contact a FEP customer service representative at 800-532-1537 or visit fepblue.org for more information.
Check the ID card
When calling Wellmark to check benefits or claim information, be sure to enter in the correct alpha characters (e.g. “AD”) in the IVR to be routed to the area designated to support that particular plan type. The patient ID is preceded by an alpha prefix (e.g., XQH). Please note that some patient IDs may have a ‘W’ after the prefix; do not enter the ‘W’ for these IDs (e.g., XQFW99999999).