This area of Wellmark.com is designed to make it easy for you to find out about important news we want to share with providers. We know you are busy, so to save you time, we’ll highlight key information and link you to the place where you can get additional information.

We’ll also include some quick facts as well as background information about Network Engagement.

• Hot Topics
• Getting Your Benefits & Claims Questions Answered
• Quick Facts 
• Network Engagement Focus 

Hot Topics

Here are a few "Hot Topics" – projects important for you to know about.

• Wellmark.com Web Enhancements  – Register for our April 17 Provider Webinar to learn about some important enhancements to the Provider portion of our website. During this Noon to 1 p.m. (CST) presentation, we’ll show you how to:

  • Save time with electronic claims remittance information (Online PCRs).
  • Easily indicate whether a claim was work related
  • Quickly access benefit accumulation information
  • Conveniently find out online why a claim was denied or payment changed due to iCAP (Improve the Claims Adjudication Process) processing

   

  Click here to register.

   

  Can’t make it? Remember, we archive all our online presentations here. Just check back when you have time. This presentation will be worth your while.
  
  

• Register for Wellmark.com – To take advantage of new web enhancements you need to have secure access to Wellmark.com. For more information about how to register visit the Register for Wellmark.com page.
  
  
• Pre-Service Review Changes – Beginning February 4, 2013, Wellmark no longer will accept pre-service review requests from contracted providers via paper fax and phone that are eligible to be submitted through the new online UM tool.  Also, additional medical information corresponding to eligible pre-service review requests only may be submitted through the new online UM tool by either electronic attachment or electronic fax.
  
  On December 15, 2012 Wellmark streamlined the pre-service review process.  This change will increase efficiency for providers and reduce the volume of retrospective reviews. For more information and to see previous webinars regarding Pre-Service Review Changes visit the Provider Education page on Wellmark.com.
  
  
• Transparency  – Blue Plans across the country are launching several new transparency tools. Learn more about what tools will be launched by Wellmark and the other Blue Plans. (pg. 12 of December 2012 Blue Ink) 
  
  
• Ancillary Claims  – Effective October 14, 2012, claims filing rules for ancillary claims (durable medical equipment suppliers, including orthotic and prosthetic suppliers, and independent clinical laboratories). Find out how to determine the “local” Plan for claims filing purposes (pg. 9 of October 2012 Blue Ink and pg. 10 of August 2012 Blue Ink). For a clarification of submitting with NPI please see page 10 of the December 2012 Blue Ink .  
  
  
• ICD-10 Updates – Keep up-to-date on ICD-10 implementation. The new implementation date is October 1, 2014. 
  

Getting Your Benefits & Claims Questions Answered

Finding answers to your benefit or claim questions is the expertise of Wellmark’s Provider Service team. We also offer several ways to self-serve for your convenience. 

Four Ways to Reach Us

1.  Go to the Provider page http://www.wellmark.com/Provider/index.aspx 

2.  Go to “Have a Question For Us?” to submit a secure question or track a question

3.  Go to “Quick Links” and click on Forms, click on Provider Claim Review Forms and then click on the Iowa Provider Inquiry Form  or South Dakota Inquiry Form  and follow instructions

4.  Contact Provider Services

Network Engagement has collaborated with Provider Service to implement an internal process for working together on provider inquiries as appropriate. If you need to talk with a staff member, please contact Provider Service at the numbers listed in the chart. These Wellmark staff members actively collaborate with the Network Engagement team as needed.

Quick Facts

94.1% Claims Submitted Electronically

86.1% Claims Requiring No Manual Intervention

Network Engagement Focus

2012-2014 Network Engagement Strategic Priorities