Know what to look for on the member ID card
Now that some Wellmark plans do not allow a copay to be collected if the patient’s out-of-pocket maximum has been met, more and more providers are taking advantage of our secure Check Member Information Web tool. As with the increased use of any tool, Wellmark has recently experienced more questions related to this one. In particular, some providers have asked about some differences between the information available online and shown on their patients’ ID cards. Here’s what to look for.
When submitting claims
The only information needed from the ID card for claims submission is the member name and the Wellmark ID number (WID). Any other discrepancies between what you see online and what you see on the ID card should not prevent you from submitting the claim. For example, group numbers sometimes change due to updates in the group’s benefits. Wellmark does not issue new cards when this happens. Please submit the claim as you normally would despite any differences in the group number.
When validating member information
- The nine-character member ID should be the same on both the ID card, and in the Web tool. Remember, some member IDs now begin with a letter, not a number (e.g., XQFW99999999).
- As mentioned above, the group number may be different in some cases. Any discrepancy of group numbers does not indicate that the card is out of date or that the card is otherwise “invalid.”
If you’ve never used our online tools to verify member information, take a look at our recently produced instructional video for checking benefit accumulations. You may also like to check out the introductory video to our Check a Claim tool.
I need secure access to:
Tools and resources related to:
- Utilization Management
Take me there.
E-credentialing Central to access these tools:
- Application Tool (coming soon)
- Change Request Tool
- Recredentialing Tool
- Provider Directory Update Tool (coming soon)
- Submission Status Tracker
- Submission History Tool
- View my Organization
- Manage my Users
Take me there.