ACA to Usher in New Process
Here's what you'll see
Look for new Wellmark ID cards
Check and compare with office records
Beginning Jan. 1, 2014, Wellmark members in the individual under-65 and small-group markets will be carrying new identification cards.
- ID cards for members with individual under-65 or small-group coverage under the new Wellmark ACA-compliant plans in Iowa and South Dakota will carry the provider network name rather than the name of the benefit plan or product. The network will be identified as WellmarkBlue PPOSM, WellmarkBlue HMOSM, or WellmarkBlue POSSM.
Our ACA-compliant plans correspond with the ACA metallic tiers as follows:
||PPO, HMO, or POS
||PPO, HMO, or POS
||PPO, HMO, or POS
||PPO or HMO
|CDHP (Consumer Driven Health Plan)
||PPO or HMO
Because a metallic tier may contain more than one benefit plan within any given network, it is especially important to check the member's benefit design. Before collecting copayment or coinsurance, be sure to determine whether the member's out-of-pocket maximum (OPM) has been reached. Coverage details are available on our secure Check Member Information tool. Check eligibility and benefits on Wellmark.com (Provider > Eligibility, Benefits & Accumulations).
- ID cards for individuals under the age of 65 who purchase their own grandfathered insurance (a health plan that existed on or before the date the ACA was signed into law on March 23, 2010) still display the name of the benefit plan, not the network. Updated cards show new alpha prefixes to member ID numbers, designed to expedite the payment of claims.
Network providers know the importance of front desk check-in. Careful monitoring of ID cards will keep things running smoothly and swiftly for all involved: health care providers, patient members and Wellmark.
Wellmark members receiving new ID cards have been instructed to destroy their old cards after Jan. 1, 2014, when the new cards become effective. If your patients have several Wellmark ID cards with them and are unsure about which one to use, check the date on the back of the cards. Reference the card with the most recent issue date when submitting claims.
Wellmark members whose insurance is provided through their place of work will have new cards only if their employers changed plans for 2014. In any case, it is best to check and compare the patient's identification card with your office records.
Ninety-day grace period allows for suspension of claims payments
Wellmark will contact providers in these instances
The Affordable Care Act provides special protections to members who purchase insurance policies on the exchange or health insurance marketplace. Individuals who don't pay their monthly insurance premiums will have a 90-day grace period before their coverage is cancelled.
Since Wellmark is not participating on the exchange or health insurance marketplace in 2014, Wellmark members will not be impacted in 2014. However, you may see a few BlueCard members covered by other Blue Plans for whom this regulation will apply.
How will this process work?
If an insured individual misses a premium payment, federal regulations require insurers to pay for services rendered the first 30 days after the payment lapse. In these cases, Wellmark will identify the Blue Plan member and send a letter to the provider on behalf of the home plan, indicating claims for the insured are pending due to a lapse in payment. If, after 90 days, payment still has not been received, Wellmark will deny the pending claims for the last 60 days. It will then be up to you, the provider, to collect the appropriate claim amount direct from the patient.
Providers can confirm claim receipt and status simply and quickly at Wellmark.com/Provider. Sign in and click Check a Claim.
Look for changes in checks and Online PCRs
New plans will result in additional documents
You may notice some changes in documents from Wellmark beginning Jan. 1, 2014, when services are provided to members with our new ACA-compliant products in Iowa and South Dakota. Expect changes when you see ID cards displaying the name of the provider network, such as Wellmark Blue PPOSM, Wellmark Blue HMOSM, or Wellmark Blue POSSM. You will access separate Online PCRs for ACA-compliant products, and the check you receive will be written on check stock reflecting the patient's coverage, rather than your practice location.
For example, if a South Dakota member sees an Iowa PPO provider, the check will be printed on South Dakota check stock, instead of on Iowa check stock.
Providers who are signed up for electronic funds transfer (EFT) may have more than one deposit. These providers could receive one deposit for services to Wellmark Health Plan of Iowa members, and separate deposits for services to members covered by our Wellmark Blue PPOSM networks in Iowa and South Dakota.
For now, few providers will be affected, but numbers will increase as more members transition to ACA-compliant products.