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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 August include:

 

Sign up now for real-time updates

The Wellmark Information Notification System (WINS) is live and you can register to receive important messages right to your inbox. The best part is you have control over the types of notifications you receive from Wellmark. To learn more about how WINS can keep you informed, register for the August 13th webinar or visit the Real-time Updates Web page on Wellmark.com.

 

Timely filing guidelines changing

Effective for dates of service on or after January 1, 2015, Wellmark claims must be received within 180 days from the date of service for professional claims or the discharge date for facility claims. Currently to be considered for reimbursement, most Wellmark claims must be received within 365 days of the date of service. For more information on Wellmark’s timely filing guidelines, refer to the Claims FilingPDF guide on Wellmark.com.

 

New prior approval requirement for varicose vein procedures

For procedures on or after September 15, 2014, prior approval will be required for certain varicose vein procedures. The Wellmark Utilization Management Tool and accompanying SmartsheetsTM can help determine medical necessity of these procedures. To determine if a procedure requires prior approval, check the Authorization Table on Wellmark.com. You can begin to submit prior approvals using the Utilization Management Tool starting September 1, 2014.

 

Implementation date for 2014 McKesson InterQual® changes and content updates

InterQual® clinical revisions were originally shared in July 2014 on the InterQual Criteria page on Wellmark.com. The revisions will be implemented the weekend of August 9, 2014. As part of McKesson Health Solutions’ content release, coding changes were made to the following services: bariatric surgery, hysterectomy, and ptosis repair. These changes will display on the Wellmark Authorization Table beginning August 9; the Authorization Table provides pre-service review requirements at the code level. The 2014 InterQual Criteria for all services requiring prior approval will be effective for any requests initiated on August 9, 2014 regardless of date of service.

 

Help us recognize local initiatives that improve community health

You may have heard that Wellmark is celebrating its 75th anniversary this year. To mark this occasion and say “thank you” for a great 75 years, we’re giving back to the communities we serve. Wellmark is awarding $7,500 to ten projects that will improve the health of Iowans and South Dakotans. If you know of any local projects that would benefit from this support, encourage them to submit an application by August 5, 2014. To submit a project and to learn more about what Wellmark is doing to say “thank you,” visit Wellmark.com/75.

 

Resources for filing ancillary claims

Ancillary claims for independent clinical labs, durable medical equipment suppliers, and orthotic and prosthetic suppliers must be filed to the appropriate Blue Cross and Blue Shield (BCBS) plan for processing as defined by the BCBS Association. For more information, visit the Ancillary Claims Web page or view the Wellmark Provider Guides on Wellmark.com.

 

File claims with the Wellmark ID

When filing paper claims, be sure to include the Wellmark ID number following the three character alpha prefix in Field Locator on the CMS-1500 claim form. The policyholder’s alpha prefix and ID number is required and must be submitted as shown on his/her identification card. The Medicare Health Insurance Claim number or the patient’s Social Security Number is not a valid Wellmark ID. For more information on the required fields to include on the CMS-1500, view the Claims FilingPDF guide on Wellmark.com.



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