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Enrollment of Practitioners in South Dakota

Apply for Participation: Enrollment Forms

(continued from Eligibility)

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Completing the Application

Wellmark accepts participation applications you previously completed for other insurers as long as:

• The information provided is current within the last 30 days, and
• The provider has re-signed the certification and release statement.

Missing information will slow the application process, so please:

• Read the application thoroughly and complete all questions.
• Include your National Provider Identifier (NPI).
• Complete all non-applicable using an "N/A" or other appropriate indicator.
• Verify the application is signed and include all requested document copies.

Step 5) Wellmark has two practitioner applications. Below is a chart briefly describing each application’s use. Read options (a) through (e) to identify which application best matches your situation.

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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.