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Enrollment of Facilities/Entities in South Dakota

Apply For Participation: Eligibility

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

Step 1) Does the facility provide services at an eligible location?

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

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

a. If the answer is "yes" to at least one network, you may continue through the enrollment process.
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 and do not need to continue through the enrollment process.

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

  • Ambulance Service
  • Chemical Dependency Treatment Facility (CDTF)
  • Dialysis Center (ERSD) — hospital-based
  • Durable/Home Medical Equipment Suppliers and Services (DME or HMESS)
  • Federally Qualified Health Center (MedicareBlue PPO only)
  • Freestanding Ambulatory Surgery Center (ASC)
  • Freestanding Magnetic Resonance Imaging Center (MRI)
  • Freestanding Radiology Center (FRC)
    • CT Center (FCT)
    • Mammography Center (FMC)
    • PET Scan Centers (PET)
    • Portable X-Ray Providers
    • Radiation Oncology Center (FROC)
    • Radiology Centers (FRC)
    • Ultrasound Center (FUSC)
  • Home Health Agency (HHA)
  • Home Infusion Therapy (HIT)
  • Hospice
  • Hospital
  • Laboratory
  • Orthotic & Prosthetic Supplier (O&P)
  • Public Health Agency
  • Rural Health Clinic (MedicareBlue PPO only)
  • Skilled Nursing Facility (SNF) — hospital based
  • Sleep Centers
  • Visiting Nurse Association

If you are not one of the listed facility/entity 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 networks, but want to submit claims and answered “yes” to question 1 and 2, continue to the next step.

Step 4) Questions regarding reimbursement methodologies?

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

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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