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Apply to Submit Claims as Non-Participating Provider

In order to submit claims to Wellmark as a non-participating provider, please complete and return the appropriate application below along with the W-9 form.  Please note:  you are required to be licensed in the state of practice and have obtained a National Provider Identifier (NPI).


Complete and submit . . .


Submit the application and W-9 to:

Wellmark, Inc.
PO Box 14509
Des Moines, IA 50306-3509



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