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Enrollment of Providers and Facilities/Entities in South Dakota

Update Your Information

Providers already participating in one or more of Wellmark’s networks need to inform Provider Application & Credentialing of the following events:

• Change in tax identification numbers;
• Change in demographic information (addresses, suite #s, phone #s, name changes, specialty changes, etc.); and
• Change in practice status (retirement, relocation, etc.)
• Add a new office location

Along with the notice of an event, please provide an effective date for each event.

These changes may result in provider number changes or may affect your contracting arrangement with us. After reviewing your request, Provider Application and Credentialing will let you know if further actions are necessary. The goal is to process all changes received within 30 days.

How to notify us:

• Complete the Provider Change Form (address, Tax ID; a completed W-9 Form must accompany any Tax ID change)
• If you wish to check on the status of a request previously sent, you may call us at 1-800-700-9137 (option 1) or 605-373-7460 (option 1), or e-mail us at providercredentialing@wellmark.com. You will receive a response to your inquiry within 24 hours of receipt.
• Practitioners: To add an additional location, complete the Professional Provider Application.
• Facilities/Entities: To add an additional location, complete the Wellmark Blue Cross and Blue Shield of South Dakota Facility Application.

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