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Apply to Contract with and Participate in Wellmark Networks

Assistance Available

If you need assistance during this process, contact our provider application and credentialing area:

Step 1: Location and Provider Types

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 to 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 approved based on location, you must also be 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.
NetworkProductPractice LocationAnswer
Indemnity Blue TraditionsSM
Classic Blue® 
Have a South Dakota address?

Yes
No

PPO Blue Select® Have a South Dakota address?

Yes
No

HMO Blue Access®
Blue Choice®
Blue Advantage®
Have a practice address in Union, Lincoln, or Minnehaha counties in South Dakota?

Yes  No

Dental FEP Dental Have a South Dakota address?

Yes
No

 

Approved Provider Types for Contracting

If you are one of the following approved provider types for contracting, your practice location will determine whether or not you are eligible to apply and participate with Wellmark.

  • Audiologist (Aud)
  • Certified Nurse Midwife (CNM)
  • Certified Nurse Practitioner (CNP)
  • Certified Clinical Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Certified Social Worker - Private Independent Practice (CSW-PIP)
  • Doctors of Chiropractic (DC)
  • Doctors of Dental Surgery (DDS)
  • 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)
  • Oral and Maxillofacial Surgeons
  • Oral Pathologist
  • Physical Therapist (PT, LPT)
  • Physician Assistant (PA)
  • Psychologist (Ph.D., Psy.D., Ed.D.)
  • Qualified Mental Health Professional (QMHP)
  • Speech Pathologist (SLP)

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.

 

Time-Saving Tips

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.

Scenario . . .

Complete and submit . . .

You are not currently on file with Wellmark, but would like to submit claims as a non-contracted practitioner.

  

 

See Step 4 below, Submit your forms 

 

Scenario . . .

Complete and submit . . .

You are applying to participate in Wellmark's networks for the first time.

 

OR

 

You are applying with Wellmark at a new office or clinic and there has been a 30-day gap in active practice between the previously credentialed location and the new location. 

 

OR

 

You have previously been denied participation in or have been terminated from Wellmark's networks.

Steps 3 and 4 below: Obtain and complete your participation agreements and submit your forms.

Scenario. . .

Complete and submit . . .

You are already credentialed with Wellmark at one or more practice locations and are applying at an additional location.

 

OR

 

You are a hospital-based provider (radiology, anesthesiology, pathologist, emergency room, hospitalists) not listed in this directory.

See Step 4 below, Submit your forms

Step 3: Complete Participation Agreements

You can participate with Wellmark individually or through a group contract.

 

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: Complete Forms

Send the application and accompanying documents to:

Wellmark, Inc.

PO Box 14509
Des Moines, IA 50306-3509




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