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Some ACA Plans Will Affect Business

Wellmark system changes you might experience

On Jan. 1, 2014, Wellmark implemented a new system to respond to electronic eligibility or claims status requests for some members with individual or small group Affordable Care Act-compliant plans.  For these members you will experience changes in the electronic response.

 

For electronic eligibility requests

When providers send in a request to inquire whether a member has other insurance, they will receive a “yes” or “no” answer within the electronic transaction response from Wellmark, along with the name of the other insurance coverage.

 

When providers send in a request for eligibility/benefits, they will receive a response for one service type at a time for members on the new system. If multiple service types are submitted (ASC X12 270) for patients who are on the new system, Wellmark will provide a response (ASC X12 271) for at least one of the service types. A message will be generated letting the provider know that requests for the other service types need to be submitted individually.

 

For claims status requests

For claim status inquires (ASC X12 276) for members on the new system, Wellmark is now able to provide line level details in our response (ASC X12 277).

 


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