Claims & Payment
Submit electronic claims
Wellmark uses Availity for electronic data interchanges (EDI) transactions including:
- Electronic claim submissions (837)
- Electronic remittance advices (ERA) (835)
- Requests and responses for eligibility and benefits (270/271)
Set up Electronic Funds Transfer (EFT) for payment
Wellmark participating providers have a contractual requirement to enroll in Electronic Funds Transfer. Complete the Electronic Funds Transfer (EFT) Enrollment Secure Site.
Be sure to contact your financial institution(s) to make certain they are aware of the CAQH CORE External Link (Council for Affordable Quality Healthcare, Committee on Operating Rules for Information Exchange) EFT and ERA operating rules. The appropriate arrangements will need to be made between you and your financial institution to accommodate the delivery of the CORE required minimum CCD+ (Cash Concentration or Disbursement including an addenda record) Data Elements necessary for re-association of the EFT payment with the ERA. CAQH CORE has developed a sample letter External Link for providers to utilize when reaching out to their financial institutions. Please refer to the Committee on Operation Rules for Information Exchange External Link for additional information pertaining to re-association.
Payment and coding policies
Learn more about Wellmark's payment and coding policies.
Appeals and inquiries Secure Site
Learn about Wellmark's post-service appeals and preservice inquiries processes.
Ancillary claims Secure Site
Learn the claims filing guidelines for ancillary services, including independent clinical laboratories, durable medical equipment suppliers and orthotics and prosthetics.
- 835 Electronic Remittance - ANSI Version 5010A1 PDF File
- 837 Institutional - ANSI Version 5010A2 PDF File
- 837 Professional - ANSI Version 5010A1 PDF File
- 837 Dental - ANSI Version 5010A2 PDF File
- 837P COB - ANSI Version 5010A1 PDF File
- 837I COB - ANSI Version 5010A2 PDF File
- 837D COB - ANSI Version 5010A2 PDF File
- 27x Batch Transaction - ANSI Version 5010A1 PDF File
- 27x Real Time Transaction - ANSI Version 5010A1 PDF File