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Provider Security Roles

By accessing Wellmark.com, contracted providers have a wide variety of secure web tools designed to save time and effort. Designated security coordinators (DSC) play an important part in making sure the assigned users in their organization have the right access to the right tools at the right time. This page can help.

 

Below is a list of all 14 security roles available to providers and their staff. Each role includes examples of tasks that can be accomplished with that type of security access. If you are a DSC and need a refresher on the process of creating new users, assigning roles, or modifying access to specific national provider identifier (NPI) numbers, please take a moment to review our Provider Maintenance Guide .

 

Claims Status Inquiry User

  • Check the status of claims using the Check a Claim tool 
  • Review a list of pending claims
  • Indicate if a claim is work related using the worker compensation questionnaire
  • View and download provider claim remittance (Online PCR) documents

 Create & Submit Claims User

  • Submit claims for professional services using the Create and Submit a Claim tool 
  • Verify whether submitted claims have been accepted or rejected
  • Learn about any errors on accepted claims

Eligibility Verification and Benefits Inquiry User

  • Access the Check Member Information tool .
  • Find out whether a member is currently covered
  • Determine whether a particular service is covered
  • Confirm how benefits would apply to a service
  • View benefit accumulations
  • Update information for coordination of benefits (COB)

Designated Security Coordinator - Provider 

  • Create, suspend or delete user accounts using the User Maintenance tool  
  • Add or remove user roles
  • Modify user access to claims and other information that pertains to all or only specific clinicians (NPI numbers) within your organization
  • Act as backup to the main designated security coordinator 

Main Designated Security Coordinator

  • Act as the primary and sole liaison between Wellmark and your organization for all security issues
  • Create, suspend or delete user accounts using the User Maintenance tool  
  • Add or remove user roles
  • Modify user access to claims and other information that pertains to all or only specific clinicians (national provider identifier numbers) within your organization 

Outpatient Diagnostic Imaging - Provider

  • Submit pre-service review requests for radiological services through the AIM Specialty Health tool 
  • Edit and track status of submitted pre-service review requests 

 

Physical Medicine Pilot on Quality - Provider (currently unavailable)

 

Provider Fee Schedule 

Provider Toolkit

  • Send and manage secure web-based messages between the user and Wellmark using the Ask a Question  and Track a Question  tools
  • Access all secure documents on Wellmark.com 

Provider PQM Tool - Provider Users 

  • Allows clinicians to view their performance scores/ratings for the HEDIS measures selected for the Physician Quality Measurement  (PQM) program
  • Provides clinicians the opportunity to approve the display of their PQM scores on the National Hospital and Doctor Finder tool. 

Secure Email - Provider 

  • Receive and respond to secure email from Wellmark 

Utilization Management - Inpatient Notification 

Utilization Management - Procedures and DME 

Web Based Inquiry 


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