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Enrollment of Facilities/Entities

Credentialing: Credentialing Criteria Review

To participate in Wellmark's networks, all facilities/entities must first complete the Iowa Statewide Universal Facility Application (PDF).  In addition, all facility/entity applications must include (if applicable):

• Copy of current Controlled Substance Registrations (both state & federal)
• Copy of current Medical License
• Explanations as required

Wellmark will review your profile, source verify certain information, and compare the profile to the following credentialing criteria.

Required Criteria

The following criteria are pass/fail, which means that meeting the criteria are requirements for credentialing.

• Facility/entity holds a current license, as applicable.
• Facility/entity is free of current Medicare or Medicaid sanctions

Other Criteria

The following criteria are pass/discuss, which means that if the facility/entity does not clearly meet the criteria, relevant information is taken to the Credentialing Committee for review as a discussion item.

• Facility/entity has current accreditation,certification status with the appropriate national accreditation/certification organization.
• If not accredited, the facility/entity must provide the most recent CMS survey report, which will be reviewed against Wellmark indicators.
• The facility/entity must have no adverse Wellmark risk management history (such as previous contracts terminated by Wellmark).

Continue to Step 2, Credentialing Committee review

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