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Enrollment of Practitioners in South Dakota

Apply For Participation: Eligibility

To complete the enrollment process, the answers to Step #1 and #2 must be yes.

Step 1) Do I practice at an eligible location?

Providers are eligible to participate in Wellmark provider networks according to the criteria below. Not all provider types are eligible for all networks.

Network Product Practice Location Answer
Indemnity Blue TraditionsSM
Classic Blue®		 Practice must have a South Dakota address
Yes  No
PPO Blue Select® Practice must have a South Dakota address
Yes  No
TPA Select FirstTM Practice must have a South Dakota address or be located in counties bordering South Dakota
Yes  No
HMO Blue AccessSM
Blue Choice®
Blue Advantage®		 Practice must be located in Union, Lincoln, or Minnehaha counties in South Dakota
Yes  No
Dental FEP Dental Practice must have a South Dakota address
Yes  No
Military Health System TRICARE Practice must have a South Dakota address
Yes  No
Medicare Advantage PPO MedicareBlue PPO Practice must have a South Dakota address
Yes  No

a. If the answer is "yes" to at least one network, you may enroll.
b. If the answer is "no" for any network, you are not eligible to participate in that network.
c. If the answer is "no" to each of the networks, you are not eligible to participate.

Step 2) Wellmark contracts only with the following provider types. However, not all provider types are eligible for all Wellmark networks.

  • Audiologist (Aud)
  • Certified Nurse Midwife (CNM)
  • Certified Nurse Practitioner (CNP)
  • Certified Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Certified Social Worker - PIP (CSW-PIP)
  • Doctors of Chiropractic (DC)
  • Doctors of Dental Surgery (DDS)
  • Oral and Maxillofacial Surgeons
  • Oral Pathologist
  • Doctors of Optometry (OD)
  • Doctors of Osteopathic Medicine (DO)
  • Doctors of Podiatric Medicine (DPM)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Professional Counselor – Mental Health (LPC-MH)
  • Medical Doctor (MD)
  • Occupational Therapist (OT)
  • Physical Therapist (PT, LPT)
  • Physician Assistant (PA)
  • Psychologist (Ph.D., Psy.D., Ed.D.)
  • Qualified Mental Health Professional (QMHP)
  • Speech Pathologist (SLP)

If you are not one of the listed practitioner types, you are not eligible to participate in Wellmark networks.

Step 3) Providers can participate in none, some, or all of Wellmark’s provider networks, and in the TRICARE network. To learn more about the TRICARE program, visit the TriWest Web site.

If you choose not to participate in any Wellmark network, but want to submit claims and answered “yes” to question 1 and 2, continue to the Step 5 under Enrollment Forms.

Step 4) Questions regarding reimbursement methodologies?

Contact Provider Relations by phone at 1-800-700-9137 or 605-373-7460.

Continue to Enrollment Forms

 



Copyright© 2008 Wellmark, Inc. All Rights Reserved.
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.


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