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Enrollment of Practitioners in South Dakota

Credentialing: Credentialing Criteria Review

To participate in Wellmark's networks, all practitioners must first complete the South Dakota Uniform Application (PDF).  In addition, all practitioner 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

• Practitioner holds a current medical license in the state in which he/she practices.
• Practitioner is required to carry at least one million dollars per occurrence and one million dollars aggregate in professional liability insurance, and attest to such coverage in his/her profile. Coverage must be current and in effect at the time of the Credentialing Committee review.
• Practitioner cannot currently be under Medicare or Medicaid sanctions.

Other Criteria

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

• Preference is given to those physicians and behavioral health practitioners who have obtained specialty certification.
• Completion of residency training is required for non-board certified MD/DOs, DPMs and DDSs. We require all other practitioners to have completed the appropriate training program.
• Practitioner must never have been convicted of, or pled no contest to, any felony charges.
• Practitioner holds a current DEA or CSR certificate, if applicable.
• Practitioner must have no current or history of state medical license disciplinary sanctions occurring in the most recent five-year period.
• Practitioner must have no history of Medicare or Medicaid sanctions during the last three years.
• Preference is given to those practitioners who have no significant malpractice history during the last five years.
• Practitioner must have no history of the loss or limitation of hospital or other organizational clinical privileges.
• Practitioner must have no unexplained chronological gaps in his/her recent professional career history. A gap is defined as a consecutive number of days of 180 or more.
• Practitioner must be free of physical or mental conditions that affect, or would likely affect, his/her ability to perform professional duties appropriately.
• Practitioner must have no adverse Wellmark risk management history (such as previous contracts terminated by Wellmark).

Our credentialing program for Primary Care Providers, OB/GYN’s and Psychiatrists may also include a site visit.

Continue to Step 2, Site Visit

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