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Joining Our Network

Step 1: Determining Eligibility

To enroll with Wellmark and provide services that can be considered for benefits, you need to be in an eligible location and area of practice.

Eligible Locations:

a. If the answer is "yes" to at least one network, you may enroll.
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 to participate.

Eligible Provider Types:

• Audiologist
• Certified Nurse Midwife (CNM)
• Certified Nurse Practitioner (CNP)
• Certified Nurse Specialist (CNS)
• Certified Registered Nurse Anesthetist (CRNA)
• Certified Social Worker - PIP (CSW-PIP)
• Doctors of Chiropractic (DC)
• Doctors of Dental Surgery (DDS)
• Oral and Maxillofacial Surgeons
• Oral Pathologist
• Doctors of Optometry (OD)
• Doctors of Osteopathic Medicine (DO)
• Doctors of Podiatric Medicine (DPM)
• Licensed Marriage and Family Therapist (LMFT)
• Licensed Professional Counselor – Mental Health (LPC-MH)
• Medical Doctor (MD)
• Occupational Therapist (OT)
• Physical Therapist (PT, LPT)
• Physician Assistant (PA)
• Psychologist (Ph.D., Psy.D., Ed.D.)
• Qualified Mental Health Professional (QMHP)
• Speech Pathologist (SLP)

Providers can participate in none, some, or all of Wellmark’s provider networks, and in the TRICARE network. The TRICARE network also covers members from the Department of Veteran's Affairs and the Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA). To learn more about the TRICARE program, visit the TriWest Web site .

Even if you don't participate in our networks, you can still submit claims to Wellmark and provide services that are eligible for benefit consideration as long as you enroll.

Step 2: Using the Correct Enrollment Forms

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.

Wellmark Application	Use when...
South Dakota Statewide Universal Practitioner Application  (1.7MB)	Applying to participate in Wellmark network for the first time; you have never applied for participation within Wellmark networks. If you are currently participating with Wellmark but not with TRICARE and are interested in applying to participate with TRICARE. View TRICARE enrollment  (26KB) for more information. Also submit these forms: W-9 Federal Tax Identification Form  (250KB) Electronic Claims Form - #S-53260  (275KB)
Professional Provider Application - #B-3308  (580KB)	Enrolling with Wellmark but do not wish to participate in any Wellmark networks. Enrolling at an additional location; you already have enrolled at least one location. Enrolling at an emergency room. Also submit these forms: W-9 Federal Tax Identification Form  (250KB) Electronic Claims Form - #S-53260  (275KB)
Wellmark Addendum  (425KB)	A South Dakota Statewide Universal Application has already been completed on behalf of another payer and the information is current within 30 days. Complete the Wellmark Addendum, attach to your existing, current South Dakota Statewide Universal Application and return both sets of documents to Wellmark.

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.

Step 3: Obtaining Your Participation Agreements

You can contract through a group when all providers bill under one common group billing number, or enroll with Wellmark individually.

Get the participation agreement designed for your provider type:

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: 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