To submit claims to Wellmark on behalf of your patients, you must apply to Wellmark. When you apply, you provide Wellmark with information needed to determine if your services are covered. Wellmark will not cover services provided prior to your effective date. Each facility and entity location is credentialed individually.
If your facility or entity is:
Wellmark uses the National Provider Identifier (NPI) to process claims. You must provide your NPI when applying to Wellmark.
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. In its sole discretion, Wellmark reserves the right not to process or accept a provider’s application.
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:
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 occurs every three years.