Enrollment of Practitioners in South Dakota

• A current state license (with no restrictions or encumbrances)
• A current Federal Drug Enforcement Agency (DEA) registration (where applicable to the practitioner’s situation)
• No history of a felony conviction
• $1 million aggregate malpractice insurance with dates/amounts of coverage attested to by the practitioner
• No history of loss/limitation of hospital privileges attested to by the practitioner
• No outstanding grand jury indictments 
• No significant malpractice

Our credentialing process may also include on-site reviews of the site policy and medical record keeping practices.

In the past, providers contracting for Wellmark's managed care products were credentialed through our NCQA-level credentialing program. Providers contracting only for non-managed products were credentialed through a more basic program. We moved to a single level of credentialing because our customers have come to expect that Wellmark networks meet NCQA standards. The vast majority of providers already meet or exceed NCQA standards and deserve the recognition these higher standards represent.

In addition to credentialing all new providers through the NCQA-level program, we are initiating NCQA-level credentialing review for all providers currently contracting only for non-managed products. On a phased geographic basis over the next few years, we will contact these providers in Iowa and South Dakota for updated credentialing information and review their credentials under the NCQA-level credentialing program.

Wellmark's NCQA-level credentialing program was developed by the Wellmark Credentialing Committee and approved by the Quality Oversight Committee. Our credentialing program includes the following elements:

• Provider attestation or source verification of credentialing information
• Meeting pass/fail/discussion criteria
• Receiving a recommendation from the Credentialing Committee

In 1998, we began to store key application data in an electronic database. This will allow us to forward preprinted/completed applications to you for updating during the Wellmark recredentialing activities. In addition, it will be used to process any requests for participation with other Wellmark networks.

Your application is entered into our database when first received. We then begin to verify key information to ensure that we are in compliance with the NCQA accreditation standards. For example, we must contact the Board of Medical Examiners to confirm the presence of a current, unencumbered license.

Other key information which must be source verified includes Medicare/Medicaid sanctions, board certification, post graduate training, and National Practitioner Data Bank information.

After all credentialing information is collected, the data is sorted and prepared for the Credentialing Committee. The Credentialing Committee makes recommendations regarding the inclusion of the provider in the Wellmark networks.

Please note that it is extremely important - for you as well as us - that we maintain accurate records on your practice or facility. For example, we have a direct link to the Internal Revenue Service (IRS) to match the tax identification number you submit with your number on file. If you change your number for any reason, and do not report it to us, the numbers will not match. The IRS may impose a penalty for incorrect reporting