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Enrollment of Facilities/Entities

Credentialing: Eligible and Exempt Facilities/Entities

By assessing and validating the qualifications of Wellmark network participants assures members that Wellmark networks are made up of the highest quality practitioners and organizational providers.

Beginning September 1, 2004, Wellmark will credential all newly contracting Iowa and South Dakota providers using Wellmark's NCQA-level credentialing program. Facilities/Entities currently contracting with Wellmark (current contracting facilities/entities) who have not previously been reviewed under this program will be taken through the process over the next several years.

Facilities/Entities Eligible for Credentialing

The following facilities/entities must be credentialed in order to be eligible for participation in any Wellmark network. Facility credentialing occurs every three years and pertains to:

• Ambulance Providers
• Chemical Dependency Treatment Facilities (CDTF) — South Dakota
• Community Mental Health Centers (CMHC) — Iowa
• Free Standing Ambulatory Surgery Centers
• Free Standing Dialysis Center — Iowa
• Free Standing MRI Centers
• Free Standing Radiology Centers
  - Mammography  Centers
  - CT Centers
  - Ultrasound Centers
  - Radiation Oncology Centers
  - PET Scan Centers
  - Radiology Centers
  - Portable X-ray Providers
• Free Standing Substance Abuse Facilities (FSSAF) — Iowa
• Home Health Agencies (HHA)
• Home Infusion Therapy (HIT)
• Home Medical Equipment Suppliers & Services
• Hospices
• Hospitals
• Laboratories
• Orthotic & Prosthetic Suppliers (O&P)
• Psychiatric Medical Institute for Children (PMIC) — Iowa
• Skilled Nursing Facilities (SNF) — Iowa

Facilities Exempt from Credentialing
Facility credentialing does not apply to hospital based departments (specifically dialysis units, birthing units, laboratory departments and radiology departments) that are not listed in the directory (those departments that are listed in the directory will be reviewed against the credentialing criteria).

Note: Any provider/department wishing to be listed in the directory is required to be credentialed regardless of the exemptions above.

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 800-700-9137 or e-mail.

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Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota. Blue Cross®, Blue Shield®, and the Cross® and Shield® symbols are registered marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.