Practitioners  How the Process Works Obtain a Provider Number Screening Hospital Based Providers  Apply for Participation  Credentialing  Update Your Information  Forms  Facilities/Entities  How the Process Works  Apply for Participation  Credentialing  Update Your Information  Forms

Enrollment of Practitioners in South Dakota

How the Process Works: Hospital-Based Providers

Radiologists, pathologists, anesthesiologists, certified registered nurse anesthetists, and emergency room physicians practicing exclusively in a hospital, or other facility setting, may not need to execute a direct agreement with Wellmark.

Hospital Billing for Services
In many instances, the hospital has an employment or contracting relationship with some or all of their hospital-based providers (HBPs). The hospital bills Wellmark using the hospital tax ID number for services provided to Wellmark members by the HBPs. Wellmark settles these claims directly with the hospital.

In this situation, the hospital may choose to execute a provider group agreement for these services. The provider does not need to execute an agreement if the hospital signs a group agreement with Wellmark. The hospital must provide a group list of all HBPs covered under their group agreement. Each HBP on the group list should complete the application process if they have not already done so at a private practice location.

Hospitals are not required to contract with Wellmark on behalf of their hospital-based providers. If the hospital does not contract for their HBPs, the HBPs, in order to participate in Wellmark networks, must sign either a direct or a group agreement with Wellmark.

Provider or Provider Group Billing for Services
In other instances, the hospital has a staffing arrangement with their HBPs. As a part of this arrangement, the individual provider or group would contract directly with Wellmark. The individual or provider group would also bill for the professional component of the service provided to Wellmark members using the individual provider or group tax ID number. Wellmark settles these claims directly with the individual provider or group.

In this situation, Wellmark will pursue a contract directly with the provider or the provider’s group.

Continue to Eligibility.

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.