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Enrollment of Practitioners

Credentialing: Current Contracting Practitioners

Beginning September 1, 2004, providers currently contracting with Wellmark who are not previously credentialed using the NCQA-level credentialing program will be reviewed in a multi-year approach.

There are three primary reasons for transitioning all providers to Wellmark's NCQA-level credentialing program.

• Our customers and members have come to expect that all Wellmark participating providers are reviewed under NCQA criteria.
• Providers can contract with any of the Wellmark networks without having to go through an additional credentialing program.
• The majority of providers already meet or exceed NCQA standards and deserve the recognition this higher standard represents.

Transition Time Frame

This transition will occur over multiple years.

• In the fall of 2004, Wellmark will begin reviewing current Iowa Level 1 MD/DOs, allied practitioners and facilities/entities associated with MD/DOs in group contracts, and hospitals.
• In 2005, Wellmark will begin review of the same categories of providers in South Dakota.
• Beginning in late 2005 or early 2006, Wellmark will initiate the credentialing review process on other allied practitioners, facilities, and entities in both states.

In the future, all providers who contract with Wellmark will be required to comply with Wellmark's NCQA-level program criteria. Providers who do not comply by the established date will move to a non-participating status. Wellmark will notify all providers and will work with each provider to reach compliance with the NCQA-level program criteria prior to the deadline.

Credentialing Process

NCQA-level credentialing includes the steps you are currently accustomed to and adds the following steps:

• Source verification
• Wellmark Credentialing Committee approval

When it is time to review a provider's credentials under the NCQA-level program, Wellmark will send a prepopulated profile based on information provided in the past.

The provider will:

• Review the information
• Update as needed, including filling in missing information
• Sign and date the profile
• Return the signed profile to Wellmark within 30 days of receipt

Wellmark will then enter the profile into the Provider Application and Credentialing department's review or credentialing cycle and tracking system, and contact the provider for any missing data.

Note: The process will not move forward until Wellmark receives all information.

Once all critical and required information is received, the application will follow the NCQA-level credentialing process:

Questions?

If you have additional questions regarding credentialing information, please review the Frequently Asked Questions About Credentialing page or contact the Provider Application and Credentialing department by phone at 800-708-1342 or e-mail.

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