Contact Us
Plans and Services Health and Wellness About Wellmark Member Employer Broker Provider
Home Provider Credentialing and Contracting
» Working with Wellmark.com 
» News
» BlueCard®
» Claims and Payment
» Medical Policies and Authorizations
» Health Management
» Credentialing and Contracting
» Medical, Dental, and Pharmacy
» Communications and Resources
» Quality and Transparency
» Health Care Reform for Providers
printer friendly Printer-Friendly Page
How the Process Works

Step 1: Apply to Wellmark

To submit claims to Wellmark on behalf of your patients, you must apply to Wellmark.  When you apply, you provide Wellmark with information needed to determine if your services are covered.  Wellmark will not cover services provided prior to your effective date.  Each facility and entity location is credentialed individually. 

 

If your facility or entity is:

  • independent, complete the application found at this site and send them to Wellmark for processing. 
  • a member of a PHO, contact the PHO to determine next steps in your enrollment process.
  • owned by a corporation, please contact Network Administration at 800-708-1342.  Wellmark considers a corporation, any organization that owns four or more sites of the same type within Iowa or South Dakota.

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

 

Begin Wellmark's enrollment process.

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. In its sole discretion, Wellmark reserves the right not to process or accept a provider's application.

  1. Wellmark makes sure your facility/entity has a current license and is free of Medicare or Medicaid sanctions. Please refer to the Contracts and Credentialing section  of the Wellmark Provider Guide for additional requirements.
  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.

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. 



Quick Links

» Authorization Table
» Credentialing Submission Tracker
» Drug Information
» Education
» Find a Doctor or Hospital
» Forms
» Health Care Reform
» ICD-10
» Medical Policies
» Provider Guides
» WINS
FacebookTwitterInstagrampinterestLinked InYou Tube