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Apply to Participate in Wellmark Networks

Step 1: Determine Provider Types and Practice Location

To apply for participation in Wellmark’s Network(s), you need to have a Practice Location in Wellmark’s plan area (Iowa/South Dakota) and you must be one of the approved Provider types listed in the tables in Chapter 2 - Requirements to Participate in Wellmark Network(s) of the Credentialing and Network Participation section of the Wellmark Provider Guide PDF.

 

If you do not meet the above requirement or you do not want to participate in any Wellmark networks but are interested in submitting claims for health care services provided to Wellmark members, you may be able to submit an application to be a non-participating provider. Go to: Apply to submit claims as a non-participating provider.

Step 2: Complete Correct Application Forms

If you are interested in contracting with Wellmark, Inc.1 for participation in any Wellmark Network, please complete and submit the appropriate application and supporting documents as indicated below.

 

ScenarioComplete and submit...

You are applying to participate in Wellmark's networks for the first time.

 

The electronic application is currently not available. You are required to complete and submit a paper application.

You are applying to Wellmark for a new office or clinic and there has been a 30-day gap in active practice between your current Practice Location and your new Practice Location.

 

The electronic application is currently not available. You are required to complete and submit a paper application.

You have previously been denied participation in or have been terminated from Wellmark’s Network(s).

 

The electronic application is currently not available. You are required to complete and submit a paper application.

 

If you are interested in contracting with Wellmark, Inc.1 for participation in any Wellmark Network for either of the scenarios listed below, use the E-cred Application Tool to submit your application electronically.

 

Effective July 1, 2017, paper submissions for these types of applications will no longer be accepted.

 

ScenarioComplete and submit...
You are already credentialed with Wellmark at one or more Practice Locations and are adding or changing a location.

Electronic application and materials:

OR

 

Application and materials:

Completing and submitting your application electronically is the most efficient process and should get you the fastest turn-around time by Wellmark. Effective July 1, 2017, paper submissions for this type of application will no longer be accepted.

You are a Hospital-based Practitioner (radiology, anesthesiology, pathologist, emergency room, Hospitalists) not listed in the directory.

Electronic application and materials:

OR

 

Application and materials:

Completing and submitting your application electronically is the most efficient process and should get you the fastest turn-around time by Wellmark. Effective July 1, 2017, paper submissions for this type of application will no longer be accepted.

  

Note: Applications are subject to change and only applications that are accessed from the above table will be accepted by Wellmark. If the table above indicates that the E-cred Application Tool can be used, it is required to use the tool to submit your application electronically.  

Step 3: Submit Forms

Once steps 1-2 are complete, both Iowa and South Dakota Providers can send the application and accompanying documents by mail:

 

Mailing Address:

Wellmark, Inc.

PO Box 14509
Des Moines, IA 50306-3509

Parcel Deliver Address:

1331 Grand Avenue

Station 5W390

Des Moines, IA 50309-2901

Step 4: Complete Participation Agreements

After submitting your application, Wellmark will send the provider Agreement(s) to you by email through DocuSign® to review, complete, and sign. To learn more about this process refer to Chapter 12 - Provider Applications of the Credentialing and Network Participation section of the Wellmark Provider Guide.

 

1 Wellmark, Inc. doing business as Wellmark Blue Cross and Blue Shield of Iowa or any of its affiliates, Wellmark of South Dakota, Inc. doing business as Wellmark Blue Cross and Blue Shield of South Dakota, or Wellmark Health Plan of Iowa, Inc., (collectively, “Wellmark”).

 

 


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