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Joining Our Network

Step 1: Determining Eligibility

To enroll with Wellmark and provide services that can be considered for benefits, your facility/entity needs to be:

1) In an eligible location.

2) An eligible facility/entity type.

Eligible Locations:

a. If the answer is "yes" to at least one network, you may continue through the enrollment process.
b. If the answer is "no" for any network, you are not eligible to participate in that network.
c. If the answer is "no" to each of the networks, you are not eligible and do not need to continue through the enrollment process.

Eligible Facility/Entity Types:

Providers can participate in none, some, or all of Wellmark’s provider networks, and in the TRICARE network. To learn more about the TRICARE program, visit the TriWest Web site .

Even if you don't participate in our networks, as long as you are enrolled, you can still provide payable services to Wellmark members.

Step 2: Using the Correct Enrollment Forms

Wellmark accepts the Iowa Statewide Universal Facility Application  (775KB) for both entities and facilities.

If ...	Then ...
You have completed the Iowa Statewide Universal Facility Application  (775KB) for another payer, managed care organization (MCO), or other entity	Complete the Wellmark Addendum  (379KB) and submit with the previously completed Universal Application.   Also submit these forms: W-9 Federal Tax Identification Form  (250KB) Electronic Claims Form - #S-53260  (275KB)
You are applying for Wellmark participation for the first time, and one of the following pertains to your facility/entity: The facility is currently a participating entity in a Wellmark network and is adding a new location; or The facility/entity has never applied to participate in a Wellmark provider network; or The facility/entity is applying to participate in Blue AccessSM, Blue Choice®, and Blue Advantage® for the first time.	Fill out, print and sign the Iowa Statewide Universal Facility Application  (775KB).   Also submit these forms: W-9 Federal Tax Identification Form  (250KB) Electronic Claims Form - #S-53260  (275KB)

Time-Saving Tips

Wellmark accepts participation applications you've completed for other insurers as long as:

• The information provided is current within the last 30 days, and
• The provider has re-signed the certification and release statement.

For faster processing of your application:

• Include your National Provider Identifier (NPI). 
• Answer all questions, putting "N/A" in any blank fields.
• Include your signature and copies of the documents requested in the application.

Financial Documentation (Provider Economics Form)

Complete and print the Facility Application Supplement Provider Economics Information Form  (43KB) and provide the requested documentation for these facility types:

• Chemical Dependency Treatment Facility (CDTF)/Freestanding Substance Abuse Facility (FSAF)
• End-Stage Renal Disease (ESRD) Facility
• Hospital
• Skilled Nursing Facility (SNF)

Step 3: Obtaining Your Participation Agreements

Facilities and entities may enroll with Wellmark individually, or through a Provider Hospital Organization (PHO).

Get the participation agreement designed for your facility/entity type:

Step 4: Submitting Your Forms

Send the application and accompanying documents to:

PO Box 14509
Wellmark Blue Cross and Blue Shield of Iowa
Des Moines, IA 50306-3509