• Enrolling with Wellmark
• Reviewing Your Application
• Recredentialing

Enrolling with Wellmark 

Facilities and Entities can enroll with Wellmark individually, through a corporate agreement, or an agreement made by your Provider Hospital Organization (PHO).  To submit claims, your facility or entity must enroll with Wellmark.  To participate in Wellmark’s provider networks, your facility or entity must complete an application and sign agreements.  Each facility and entity location is credentialed individually. 

If your facility or entity is:

• independent, complete the application materials and agreements found at this site and send them to Wellmark for processing. 
• a member of a PHO, contact the PHO to determine next steps in your enrollment process.
• owned by a corporation, please contact Network Administration at 800-708-1342.  Wellmark considers a corporation, any organization that owns four or more sites of the same type within Iowa or South Dakota.

Wellmark uses the National Provider Identifier (NPI) to process claims. You must provide your NPI when enrolling with Wellmark.

Begin Wellmark's enrollment process.

Reviewing Your Application

Wellmark reviews your application and calls or sends a letter to gather any missing information. Once all the required information is received, your application will follow the credentialing process:

1. Wellmark makes sure your facility/entity has a current license and is free of Medicare or Medicaid sanctions. Please refer to the Contracts and Credentialing section  of the Billing Guide for additional requirements.
2. Credentialing Committee review - A committee of seven (six Wellmark providers and the Wellmark medical director) reviews your information and notifies you of its decision within 60 days.

Hospital-based facilities participate as part of the hospital contract.

The following hospital-based facilities are not required to credential individually if they share the hospital’s Taxpayer Identification Number (TIN), are governed by the hospital, and do not wish to be listed individually in Wellmark’s provider directory:

• Dialysis unit
• Home health agency
• Hospice
• Rehabilitation
• Sleep center
• Skilled nursing facility
• Psychiatric unit
• Swing-bed

Although they may share their hospital’s TIN, some of these hospital-based facilities (dialysis unit, home health agency, hospice, sleep center, and skilled nursing facility) are eligible to be listed separately in Wellmark’s provider directory. To be listed in the directory, a hospital-based facility must be credentialed individually, and have its own NPI.

Recredentialing 

Recredentialing occurs every three years.