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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 September include:


Countdown to ICD-10 – Will your practice be ready?
With the ICD-10 compliance date less than a month away, it is important that you prepare for the transition. ICD-10 offers additional specificity to the current ICD-9 claims reporting process. This increased granularity of choices creates an influx of codes available for the services rendered. Due to the high volume of codes available, Wellmark will be removing certain ICD-9 codes from the provider guides and will not provide ICD-10 translation. Wellmark does not offer coding advice on claims, so please submit the appropriate code(s) for the services rendered. To ensure a smooth transition, Wellmark strongly recommends all providers test claims through our electronic testing environment. To start testing or for ICD-10 resources, visit the ICD-10 page.


Drug pricing frequency change

Wellmark currently releases a quarterly drug fee pricing update. Wellmark has analyzed the aggregate payment impact of the quarterly drug fee pricing schedule and there is less than a .02 to 1.0 percent increase or decrease in price variation for established drug fees. The frequency of the quarterly drug schedule update results in an increased number of suspended claims which can lead to increased administrative time (provider and Wellmark) and a delay in claims processing. Given these findings, Wellmark is transitioning to a semi-annual drug fee pricing schedule update which will occur in January and July of each calendar year.  This change is effective immediately and applies to Home Infusion Therapy, MD/DO’s and outpatient facilities.  There is no change to the drug calculation methodology. Wellmark will continue to provide pricing for any new drug CPT or HCPC codes at the codes’ effective date. Please contact your Network Engagement Business Partner if you have any questions.


Learn how upcoming credentialing policy changes will affect you
Tune in for our September webinar titled, “Credentialing Policy Updates,” to be the first to hear about upcoming credentialing policy changes and how they will impact how you do business with Wellmark. In this webinar you will learn about the policy changes, as well as get a sneak peek into the revised Contracts and Credentialing section of the Wellmark Provider Guide . This revised section will offer more transparency and clarity on the credentialing process, becoming a participating provider, and executing a provider agreement with Wellmark. Join us September 9th as we introduce the new guide and inform you of the changes. Register now!


Get faster response to your claims inquiries
Wellmark has discovered that many providers need clarity around the provider inquiry process. Some providers do not know that the online Ask and Track a Question tool can be used to modify claims, request claim reviews, and submit supporting documentation. The truth is, online inquiries are processed no differently than those submitted on paper; one is no “more formal” than the other. But there is one difference. Online inquiries are usually less time intensive for you, and result in a faster reply from Wellmark. To ensure that you know about the option to submit inquires online, Wellmark has updated the provider inquiry form  to include guidance and hyperlinks to the tool itself. But you don’t need the form to access the tool. Just log in to the secure Check a Claim tool, find your claim, and select “Inquire or Submit Documents on this Claim” from the drop-down menu.


We’ve also made a few enhancements to the Ask & Track a Question tool when managing the responses you get from Wellmark. The enhancements include:

  • Filtering messages - to whether they have been read or unread.
    • Unread messages will appear in bold type. After opening a message or using the check box to mark it as read, the message will appear in regular type.
  • Filtering by message type - to select whether the response from Wellmark is a “status” update to let you know that we are working on your inquiry, versus a “final” update that provides you with an answer or resolution to your original inquiry.
  • Pagination - to help you move easily from page to page.
  • Records displayed – ability to display up to 100 records.

For more information on the new features, check out the Provider Inquiry Process and Enhancements webinar slides.


It’s almost flu season. Are you prepared?

With the flu season just around the corner, it’s important to prepare ahead of time and understand the specific requirements for how these services are billed. Home Health Agencies (HHAs) billing for the administration and the drug charge must credential with Wellmark as a public health agency (PHA) or visiting nurse association (VNA) and submit vaccinations and administrations individually on a CMS-1500 (837P), assuming the HHA meets the criteria to do so. In addition, the provider may need to apply for a separate national provider identifier (NPI). For more information, refer to the General Medical section of the Wellmark Provider Guide .


Attention all non-participating providers
Wellmark has expanded the view of claims details within the Check a Claim tool to give you more information on your patients’ claims. Now, you will have access to see:

  • Date the claim was paid
  • Amount paid on the claim
  • Name of the payee
  • Whether the claim is pending
  • Whether the claim was denied
  • Specific reason for denial of the claim

The availability of these additional claims details means that you now have access to all the information our customer service agents do. That means less time on the phone so you can concentrate on what matters most- the health of your patients. Need help using the tool? No problem. Check out the Provider Video Gallery for short instructional videos.


Two process improvements for pharmacy
Wellmark made two recent process improvements to simplify the prior authorization process for drugs. Previously there was a separate form for each drug or class of drugs. Now most of the drugs or classes of drugs are combined into one Universal Prior Authorization fax form , with the exception of the Synagis® form. In addition, Wellmark now provides online access to Wellmark pharmacy policy criteria. You can now quickly find which drugs require prior authorization and retrieve any accompanying medical necessity criteria. For more information, go to the Specialty Pharmacy Programs page under Drug Information.


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