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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 April include:

 

Most provider Web inquiries are now answered in one or two business days

Wellmark is dedicating more resources to answering to your secure Web inquiries. You can now expect an answer within one to two business days. If your inquiry requires further research or additional information, we will send you an update through the Ask and Track a Question tool to let you know the status of your inquiry. Through the tool, you can inquire about claims and track all responses from Wellmark. This option is much more efficient than calling Wellmark for an update. Start taking advantage of this improved turnaround time today, and submit inquiries online at Wellmark.com!

 

Get connected faster on phone calls

To save you time and ensure your phone inquiries are handled as efficiently as possible, be sure to enter your national provider identifier (NPI) when you call. Doing so allows our customer service associates to have your information at their fingertips, so they can serve you faster. In April, we will ask for your NPI each time you dial in to our provider service center. Be sure you have your NPI handy before you pick up the phone. Incorrect or invalid entries will slow you down or log you out of the system entirely.

 

Learn how to handle overpayments

Overpayments happen, but do you know how to manage them efficiently? Join us April 8 for a webinar to learn more. This webinar will help you understand overpayments, show you how to access yours and provide tips for managing them. Register today!

 

Avoid delays in processing Medicare-related claims

For Medicare-related claims, please wait 30 calendar days from the Medicare Remittance Notice (MRN) before submitting the claim to Wellmark. This will reduce duplicate processing and claims denials and improve the consistency of claims payment. Upon receipt, Wellmark will look for remark codes N89 or MA18 on the claim for indication that the claim was crossed over. When N89 or MA18 is present, Wellmark will review the Medicare Adjudication date. If the date is not 30 days or more, the claim will be rejected by Wellmark. For more information on Wellmark’s processing of Medicare-related claims, refer to the Claims Filing Provider Guide.

 

New DME claims processing when Wellmark is secondary

Based on provider feedback, Wellmark is changing the durable medical equipment (DME) or home medical equipment (HME) policy to be consistent with the primary payer. This only applies when Wellmark is the secondary payer. Effective for dates of service May 1, 2015, and after, Wellmark will follow the member’s primary payer’s policy. For example, if the primary payer considers DME or HME to be purchased, Wellmark will also consider the equipment purchased. Please include the primary explanation of benefits (EOB) when submitting secondary DME/HME claims for processing. This policy change is effective for all lines of business. For more information, refer to the HME, Orthotics, and Prostheses Provider Guide.

 

Association mandate impacts air ambulance claims

Effective April 19, 2015, claims from providers of emergency and non-emergency air ambulance services provided within the United States, U.S. Virgin Islands, and Puerto Rico must be filed to the local Plan in whose service area the point of pickup zip code is located. When the member’s pickup location is outside these areas, claims should be filed to BlueCard Worldwide® for processing. If the zip code indicated on the claim is not in the Plan’s service area, incorrect or not listed, the claim will be denied.

 

Avoid timely filing claim denials

To ensure your claims are processed, please know that Wellmark’s timely filing guidelines have changed. Beginning with dates of service on or after Jan. 1, 2015, claims submitted to Wellmark must be received within 180 days from the date of service or the discharge date. The change also applies to coordination of benefits claims. Wellmark must receive these claims within 180 days from the issue date of the primary payer’s explanation of benefits (EOB). For more details, please refer to the Claims Filing Provider Guide.



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