Apply to Wellmark
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 does not cover services provided prior to a provider's effective date.
Wellmark uses your National Provider Identifier (NPI) to process claims. You must provide your NPI when enrolling with Wellmark.
Begin Wellmark's application process or review the process as described below.
Wellmark Reviews Your Application
Once you submit your application, Wellmark reviews the information and calls or sends a letter to gather any missing information. When required information is received, applications are reviewed. In its sole discretion, Wellmark reserves the right not to process or accept a provider's application.
If you are applying for participation in a Wellmark network, your application will follow the credentialing process described below:
The following practitioners are not required to credential with Wellmark, unless they wish to be listed in Wellmark's provider directory:
The following practitioners are not credentialed:
Recredentialing occurs every three years. If you are participating, Wellmark will send the recredentialing documents to you well in advance of your recredentialing due date.
To avoid being terminated from Wellmark’s provider network(s), you must complete the document and return to Wellmark within the timeframe identified in the notice.
Application Rules for Hospital-Based Practitioners
Hospital-based practitioners are radiologists, pathologists, anesthesiologists, certified registered nurse anesthetists, emergency room physicians, and hospitalists practicing exclusively in a hospital or other facility setting. These practitioners need to apply to Wellmark. However, depending on the situation, these practitioners may not need to execute a contract for participation with Wellmark.
Hospital Billing for Services
A hospital may have an employment or contracting relationship with some or all of their hospital-based providers. The practitioner services are submitted by the hospital to Wellmark using the hospital taxpayer ID number and NPI. Wellmark settles these claims directly with the hospital.
In this situation, the hospital executes a provider group agreement. If the hospital signs a group agreement with Wellmark, the provider does not need to execute an agreement. The hospital must provide a group list of all hospital-based providers (HBPs) covered under their group agreement. Each HBP on the group list should complete the application process if they have not already done so at a private practice location.
Provider or Provider Group Billing for Services
Some hospitals have a staffing arrangement with their hospital-based providers. As a part of this arrangement, the individual practitioner or group would contract direct with Wellmark. The individual or provider group bills for the professional component of the service using the appropriate individual or group taxpayer ID number and NPI to Wellmark members. Wellmark settles these claims directly with the individual provider or group.