Step 1: Determining Eligibility
To contract 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:
| Network |
Product |
Practice Location |
Answer |
| Indemnity |
Blue TraditionsSM
Classic Blue® |
Service location must have a South Dakota address |
|
| PPO |
Blue Select® |
Service location must have a South Dakota address |
|
| TPA |
Select First® |
Service location must have a South Dakota address or be located in counties bordering South Dakota |
|
| HMO |
Blue Access®
Blue Choice®
Blue Advantage® |
Service location must be located in Union, Lincoln, or Minnehaha counties in South Dakota |
|
| Dental |
FEP Dental |
Service location must have a South Dakota address |
|
| Military Health System |
TRICARE |
Service location must have a South Dakota address |
|
| Medicare Advantage PPO |
MedicareBlueSM
PPO
|
Service location must have a South Dakota address |
|
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:
- Ambulance Service
- Chemical Dependency Treatment Facility (CDTF)
- Dialysis Center (ERSD)
- Durable/Home Medical Equipment Suppliers and Services (DME or HMESS)
- Federally Qualified Health Center (MedicareBlue PPO only)
- Freestanding Ambulatory Surgery Center (ASC)
- Freestanding Radiology Center (FRC)
- CT Center (FCT)
- Magnetic Resonance Imaging Center (MRI)
- Mammography Center (FMC)
- PET Scan Centers (PET)
- Portable X-Ray Providers
- Radiation Oncology Center (FROC)
- Radiology Centers (FRC)
- Ultrasound Center (FUSC)
- Home Health Agency (HHA)
- Home Infusion Therapy (HIT)
- Hospice
- Hospital and Specialty Hospital
- Laboratory
- Orthotic & Prosthetic Supplier (O&P)
- Public Health Agency/Visiting Nurse Association (PHA/VNA)
- Rural Health Clinic (MedicareBlue PPO only)
- Sleep Centers
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 provide payable services to Wellmark members.
Step 2: Using the Correct Enrollment Forms
Wellmark accepts the Facility Application #S-3620  (571KB) for both entities and facilities.
Also submit these forms:
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 - #S-3621 (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 & Specialty 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
|
