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How the Process Works

Step 1: Enrolling with Wellmark

To provide services that can be considered for benefits, you need to enroll with Wellmark. Wellmark does not cover services provided prior to your effective date with Wellmark.

Wellmark uses the National Provider Identifier (NPI) to process claims. You must provide your NPI when enrolling with Wellmark.

To enroll with Wellmark, complete the Iowa Statewide Universal Facility Application  (775KB).

Step 2: Reviewing Your Application

Wellmark reviews your application and calls or sends a letter to gather any missing information. Once all the required information is received, your application will follow the credentialing process:

1. Credentialing criteria review  (22KB) - Wellmark makes sure your facility/entity has a current license and is free of Medicare or Medicaid sanctions.
2. Credentialing Committee review - A committee of seven (six Wellmark providers and the Wellmark medical director) reviews your information and notifies you of its decision within 60 days.

Hospital-based facilities participate as part of the hospital contract.

The following hospital-based facilities are not required to credential individually if they share the hospital’s Taxpayer Identification Number (TIN), are governed by the hospital, and do not wish to be listed individually in Wellmark’s provider directory:

• Dialysis unit
• Home health agency
• Hospice
• Rehabilitation
• Sleep center
• Skilled nursing facility
• Psychiatric unit
• Swing-bed

Although they may share their hospital’s TIN, some of these hospital-based facilities (dialysis unit, home health agency, hospice, sleep center, and skilled nursing facility) are eligible to be listed separately in Wellmark’s provider directory. To be listed in the directory, a hospital-based facility must be credentialed individually, and have its own NPI.

Recredentialing

Recredentialing occurs every three years.