Electronic Claims Require NPI Effective August 1

Effective August 1, 2008, Wellmark will require a National Provider Identifier (NPI) on electronically submitted claims. Claims received after July 31, 2008, using legacy provider number(s) only, will reject.

Wellmark will validate the NPI by matching the billing and rendering provider numbers, the first date of service or admit date, and the provider tax identification number. If this claim information does not match information previously reported to Wellmark, the claim will reject.

Paper Submitters: Rejected claims and reject messages will be found on the Wellmark Claim Confirmation Detail Report (.z16). Professional claims will reject with the message “Claim NPI data not found”; institutional claims will reject with the message “Provider NPI data not found.”

Starting November 15, 2008, Wellmark will reject claims that are submitted with both the NPI and legacy provider numbers.

Electronic Remittance Advice (835)
Beginning January 1, 2007, Wellmark Blue Cross and Blue Shield began reporting the National Provider Identifier (NPI) on the Electronic Remittance Advice (4010A1 ANSI 835). After January 1, Wellmark will not report Wellmark provider number if the company has been notified of the provider’s NPI. The ERA will continue to report the taxpayer identification number.

Wellmark has updated the Wellmark 835 Companion Guide (PDF) to reflect this change. Please share this information with your software vendor, clearinghouse, or billing service.

If your software or clearinghouse cannot accept the NPI in your Electronic Remittance Advice, or if you have other concerns, please contact EC Solutions at 800-407-0267 or via e-mail at ecsolutionsdsm@eds.com.

Electronic Claims (837) Testing
Wellmark strongly encourages testing your NPI on electronic claims. Testing ensures that Wellmark's records reflect the correct NPI and eliminates potential payment interruptions. Once you successfully complete electronic claims testing, you can transmit electronic claims to Wellmark with your NPI only.

To begin testing with Wellmark:

1. Contact your practice management system, billing service, clearinghouse, and any other business associates to determine if you require an upgrade to your system prior to being able send an NPI-only test file to Wellmark.

2. Report your NPI(s) to Wellmark

3. Contact EC Solutions at 800-407-0267 when you are ready to electronically submit an NPI-only test file to Wellmark.

4. EC Solutions will contact you when you have been set up to submit a file into Wellmark's test environment.

5. Upon receipt of your test file, Wellmark will determine if you are ready to move into production:

• If testing was successful, an EC Solutions representative will instruct you to send NPI-only claims into Wellmark’s production environment.
• If there was an error in your test file, an EC Solutions representative will contact you. Note: Wellmark cannot always provide guidance on how to correct the error. Wellmark can only assist in providing information about how your claim would pay based on the way we received your NPI.

To find out more about the testing process, use Wellmark's Testing Toolkit (PDF).

If you are a direct submitter and you use the INet to submit your claim files, you may access the INet Testing Toolkit through the Account Library for testing processes.

If you choose to test with Wellmark, you will need to access our Model Office Application through EC Solutions. If you do not have access or require a password reset, please contact EC Solutions at 800-407-0267.

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