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 August include:
Avoid ICD-10 claims denials by testing now
Providers everywhere are preparing for the introduction of the International Classification of Diseases, 10th Revision (ICD-10). That includes taking steps to minimize business disruption that could result from denied ICD-10 claims on and after Oct. 1, 2015. To reduce the likelihood of claims being denied due to improper coding, please start testing your claims for your most common diagnoses and procedures through our electronic testing environment . As you do so, please remember the following:
- If you work with a claims clearinghouse, confirm that your vendor will conduct end-to-end testing of your ICD-10 claims. (Provider > Clearinghouse > Wellmark > Clearinghouse > Provider)
- Know that inpatient facility claims require both ICD-10 diagnoses and procedure codes.
- Remember that ICD-9 and ICD-10 diagnosis and procedure codes cannot appear on the same claim.
For more information, including step-by-step guidance for submitting your test claims, visit the Wellmark ICD-10 Testing Instructions page.
Stay in Wellmark networks
Participating practitioners, facilities, and entities are recredentialed every three years for all Wellmark networks. Approximately six months prior to their credentialing ending, Wellmark will send a Provider Recredentialing Application to complete and return within 30 days. Failure to complete and return the application within 30 days, may result in termination from Wellmark networks. To make sure you receive the Provider Recredentialing Application, it’s important that the information you have on file with Wellmark is accurate and up-to-date. Please be sure to notify Wellmark of any changes by completing the Provider Change Form. For more information on recredentialing, refer to the Contracts and Credentialing section of the Wellmark Provider Guide.
Subscribe to BlueInk for faster delivery
Did you know that the online version of BlueInk — Wellmark’s flagship provider publication — is available several days before the hard copy is mailed out? And, the electronic version has convenient hyperlinks throughout the text, enhancing your reading experience. Subscribe today to receive publication notices right in your inbox.
2015 McKesson InterQual® clinical revisions
Wellmark has published the 2015 annual changes to the InterQual® criteria 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, and a Wellmark Information Notification System (WINS) message will be sent when the changes have been implemented. For more information and to view the changes, visit the InterQual® Criteria page on Wellmark.com.