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Enrollment of Facilities/Entities in South Dakota

Apply for Participation: Submitting Your Enrollment Forms

(continued from Enrollment Forms or Participation Agreements)

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Step 9) Providers who are interested in obtaining a provider guide may download the provider guides, or complete a Provider Forms Order Form.

Step 10) Package all documents and any other documentation requested on the application and return them to:

Network Administration
Wellmark Blue Cross and Blue Shield
PO Box 14509
Des Moines, IA 50306-3509

Please review the following checklist to assure all the necessary documentation is being submitted.

• Facility Application
• Supplemental application documents as defined on the application
• Federal W-9
• TRICARE Participation Information Forms

Thank you for your interest in serving Wellmark Blue Cross and Blue Shield of South Dakota customers. For questions during the enrollment process, please contact Provider Application and Credentialing by e-mail at providercredentialing@wellmark.com or call us at 1-800-700-9137 (option 1) or 605-373-7460 (option 1).

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.