Welcome to Working with Wellmark.com, your source for news, information and tips for making the most of the resources available on our secure provider website. This page is designed for all providers with secure access to Wellmark.com. General users will learn about easy-to-use Web tools, while designated security coordinators (DSCs) will learn how to manage security roles within their organization.
Looking for something in the Credentialing Submission Tracker?
Since the introduction of the Credentialing Submission Tracker last fall, most providers are now using this tool as their primary resource for knowing the status of their applications, recredentialing submissions or change requests. Since results can display on the tracker for 90 days after the notification has been sent, providers with multiple submissions may have to sift through a few results to find the one they’re looking for. When your list seems too long, here are some tips:
- Limit the number of individual national provider identifier (NPI) in your search.
- Note that the most recent submissions appear at the bottom of your list.
- Pay attention to the submission type, which always appears immediately after the provider’s name.
- Remember, returned submissions always will appear in red under “Status.”
Reminder: timely filing guidelines have changed
To ensure your claims are processed, please know Wellmark’s timely filing guidelines have changed. Beginning with dates of service on or after Jan. 1, 2015, claims submitted to Wellmark must be received within 180 days from the date of service or the discharge date. The change also applies to coordination of benefits claims. Wellmark must receive these claims within 180 days from the issue of the primary payer’s explanation of benefits (EOB). For more details, please refer to the Claims Filing section of the Wellmark Provider Guide.
Web Tools and How-to Videos
Put down the phone. Chances are the information you’re looking for is online. Listed in order of popularity, the resources featured below show you how to make the best use of our secure Web tools. Many are also included in our Provider Video Gallery.
- Check claim status video . (2:44 min.)
- Follow up on a denied claim with attachments video . (3:06 min.)
- Check benefit accumulations video . (3:30 min.)
- Resolve possible workers’ compensation claims video . (3:18 min.)
- Download provider claims remittances (PCR) presentation .
- Get pre-service authorization resource page.
- Request pre-service review for out-of-area members video . (4:05 min.)
- Create and submit a new claim video . (12 min.)
Resources for DSCs
Designated security coordinators play a unique role in Wellmark’s Web security protocol. There are two types of DSCs. The “main DSC” has several responsibilities, including signing Wellmark’s usage agreement on behalf of his or her organization. The second type is simply known as “DSCs.” Each organization has one main DSC, but he or she can assign the DSC role to any number of individuals. Both types of DSCs can assign roles to other users to access certain tools and resources on Wellmark.com. To be effective in their role and maintain their organization’s security access, DSCs should be familiar with the following:
Information and Web Security
We all understand the need to protect our patients’ privacy while serving them efficiently. The following resources help keep providers and our members informed about this important topic: