If you need assistance during this process, contact our provider application and credentialing area:
Step 1: Determine Eligibility
To apply to Wellmark, you need to be in an approved location and be an approved provider type for contracting as shown below. To provide services that can be considered for benefits, you must first apply with Wellmark. In its sole discretion, Wellmark reserves the right not to process or accept a provider's application. Wellmark will notify you of your effective date.
After you apply, Wellmark will be able to identify basic information about you when a claim is submitted, such as your National Provider Identifier (NPI), location, provider type, and specialty. Your services will be eligible for coverage beginning with your effective date; services provided prior to that date are not covered.
If approved, you may decide to participate with one or more Wellmark networks. If you are interested in participation, you need to complete Step 3. You will find a list of participation advantages under Step 2.
Eligible Practice Locations
Your location determines whether or not you are eligible to apply and to participate with Wellmark. If you are eligible based on location, you must also be an approved provider type for contracting. If you are an approved provider type for contracting, and:
- If the answer is "yes" to at least one network below, you may apply and provide services after your effective date. You may also participate in that particular network(s).
- If the answer is "no" for any network, you are not eligible to participate in that network.
- If the answer is "no" to each of the networks, you are not eligible to apply or participate.
Note: The following providers do not have to be physically located in South Dakota or in a county bordering South Dakota to participate in Wellmark's Indemnity, PPO and HMO networks.
- Independent Clinical Laboratories, Durable/Home Medical Equipment Suppliers and Orthotic and Prosthetic Suppliers, see the ancillary claims information regarding claims filing rules for these provider types.
- Air ambulance providers, see the General Medical Provider Guide regarding claims filing rules for air ambulance providers.
Continue the application process in Step 2.
|Have a South Dakota address?
||Have a South Dakota address?
|Have a practice address in Union, Lincoln, or Minnehaha counties in South Dakota?
Approved Provider Types for Contracting
If you are one of the following approved provider type for contracting, your practice location will determine whether or not you are eligible to apply and participate with Wellmark.
Note: Wellmark is not accepting applications from home infusion therapy (HIT) providers for participation in the provider networks. HIT providers may complete an application for consideration as non-participating.
Step 2: Complete Correct Application Forms
Depending on your provider type and practice location, you may be approved to participate in some or all of Wellmark's provider networks.
If you participate with Wellmark, you will:
- Receive direct payment from Wellmark for covered services
- Be listed in Wellmark's provider directory
- Have access to additional information from Provider Service.
- Be eligible to access complete claim and member benefit information on Wellmark's secure website.
If you decide not to participate but wish to provide services that are eligible for benefit consideration, you must apply to Wellmark and provide services after your effective date with Wellmark begins. Wellmark will send you your effective date after your application is processed.
Avoid completing unnecessary paperwork or processing delays by reviewing the following tips.
- Send Wellmark your participation applications completed for other insurers. Wellmark accepts these applications if:
- The information provided is current.
- The provider has re-signed the certification and release statement.
- A completed Wellmark Addendum is included with the application. The Addendum asks for specific information that Wellmark needs to process your application.
- Provide complete information 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.
- Include your agreements if participating in one or more Wellmark networks.
- Complete updated documents using the links below. Dispose of any paper stockpile you may have, as Wellmark's contracts have been updated to reflect a change in signature authority. Other addendums or applications now request additional information.
Step 3: Complete Participation Agreements
You can participate with Wellmark by location or through a corporate contract. Wellmark considers a corporation any organization that owns four or more sites of the same type within Iowa or South Dakota.
Wellmark strongly encourages out-of-state independent clinical laboratories and durable medical equipment suppliers to sign both Iowa and South Dakota provider agreements. Out-of-state providers who sign with Wellmark will be added to the Wellmark provider directories as in-network for both Iowa and South Dakota members.
To locate participation agreements for which you may be eligible, select your provider type, then Go:
Note: To avoid delays in processing your application or contract, please access updated documents using the links below. Please dispose of any paper stockpile you may have. Wellmark's contracts have been updated to reflect a change in signature authority, while other addendums or applications now request additional information.
Step 4: Submit Forms
Send the application and accompanying documents to:
PO Box 14509
Des Moines, IA 50306-3509