In order to submit claims to Wellmark as a non-contracted provider, please complete and return the Provider Non-Contracting Application and W-9 form. Please note: you are required to be licensed in the state of practice and have obtained a National Provider Identifier (NPI).
Submit the application and W-9 to:
PO Box 14509
Wellmark Blue Cross and Blue Shield of Iowa
Des Moines, IA 50306-3509