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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 March include:


Delay in March for some ID cards
In light of recent marketplace activities, Wellmark has extended the deadline for applications for small group coverage effective March 1, 2015. This may cause a delay in sending ID cards to some Wellmark members. If a Wellmark member visits your office in March prior to receiving his or her ID card, please use the “Member Number Lookup” feature within the Check Member Information tool to verify coverage.


Association mandate affects claims
Effective April 20, 2015, members will no longer be responsible when a claim is denied for additional information being requested from the provider. This liability will fall on the provider; therefore, Blue Cross and Blue Shield members cannot be billed for claims denied for this reason. Please note that all Wellmark lines of business are impacted by this Association mandate, including the Federal Employee Program (FEP) and BlueCard claims. This change will be reflected on your Online Provider Claim Remittance (PCR) or the 835 electronic transaction for all claims denied after April 19, 2015.

Thousands have already registered for WINS. Are you missing out?
Are you getting messages from the Wellmark Information Notification System (WINS)? Well, your colleagues probably are! Since the provider notification service 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 learn more, join our webinar on March 11. Ready to start now? Register for WINS through our secure provider page. To begin receiving messages, please provide us with a few details, including your preferred email address, and then subscribe to the message categories you’re most interested in. Registration takes only a few minutes!


Accurate information helps home ventilator claims process
Recently, the HME, Orthotics, and Prostheses Provider Guide  was updated to reflect changes to billing requirements for home ventilators. Wellmark allows a primary and a backup ventilator for Wellmark members in the home setting. Wellmark requires the billing of the primary ventilator as a purchase and the backup ventilator as a rental using the appropriate ventilator code and modifier(s). Be sure that you provide Wellmark with accurate information on the claim to help it process smoothly and efficiently. For more information, review pages 9-10 of the HME, Orthotics, and Prostheses Provider Guide .


Enhancement eliminates need to request Web inquiry status
Are you receiving email responses from Wellmark about the status of your inquiry? If so, we’re just letting you know that we’re working on an inquiry you sent via the Ask and Track a Question tool. In most cases, Wellmark staff are able to answer your question relatively quickly without sending a status update. For more complex inquiries, such as those pertaining to claims adjustments, your customer service agent may opt to send you an update informing you that we need more time. These status updates are not automated, but they do include a hyperlink that corresponds to your inquiry so you can get more information online.


New resources help you prepare for continued stay reviews
If you provide skilled level care, Wellmark has created three resources to help you submit correct information to Wellmark for initial and continued stay reviews. The Skilled Nursing Facility Guide - Iowa  and Skilled Nursing Facility Guide – South Dakota  are documents that outline specific information Wellmark nurses need in order to complete initial and continued stay reviews. In addition, a Skilled Nursing Facility Flow Sheet  was developed to assist you when reporting a patient’s progress with physical and occupational therapy services. Access the documents today on the Provider Forms page or for more information, refer to the Preparing for Continued Stay Reviews webinar.


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