Provider Change Form

 

This page is no longer available, but there's a faster and easier way to submit your change requests.

 

Log in to E-credentialing Central and use the Change Request Tool.

Not registered to log in to E-cred Central? Get started now!

 

© Wellmark, Inc. All Rights Reserved.
Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., Wellmark Blue Cross and Blue Shield of South Dakota, Wellmark Synergy Health, Inc., and Wellmark Value Health Plan, Inc. are independent licensees of the Blue Cross and Blue Shield Association.
 
Privacy & Legal