Working with Medicare Advantage
Resources and guidance for working with Wellmark Advantage Health Plan.
Forms and resources
Forms and resources for working with Wellmark Advantage Health Plan.
Claims
Provider manual, benefit policy papers and tip sheets to support claim submission.
Utilization management
Preservice medical authorizations and medical policies, including Part B drugs.
Part D policies
View information and resources on Medicare Advantage Part D polices.
Part D formulary and policies
- 2026 Prior authorization and step therapy criteria
- Medicare prescription drug coverage determination and authorization form (also for authorizations and exceptions)
- Blue Medicare Advantage HMO request for redetermination form
- Part D formulary search
- Iowa Blue Medicare Advantage PPO Formulary
drug list formulary PDF - South Dakota Blue Medicare Advantage Classic PPO and Enhanced PPO formulary
drug list formulary PDF
Plan benefits information
evidence of coverageIowa Blue Medicare Advantage PPOevidence of coverageIowa Blue Medicare Advantage Valor PPOevidence of coverageSouth Dakota Blue Medicare Advantage Classic PPO and Enhanced PPOevidence of coverageSouth Dakota Blue Medicare Advantage Valor PPO
Log in to portal
Log in to the provider portal, scroll down to the Wellmark Advantage Health Plan section and click on Wellmark Advantage Health Plan Provider Portal to check eligibility and claim status and manage authorization for Wellmark Advantage members.
Keep your directory information up to date
Log in to E-Credentialing anytime to validate or update your information. As a reminder, providers must validate directory information every 90 days. Watch for notices from BetterDoctor® via email, fax, direct mail and/or phone.
Learn more about BetterDoctor.
Disclosures
BetterDoctor® by Quest Analytics is a separate company that helps maintain an accurate directory of network providers on behalf of Wellmark Blue Cross and Blue Shield.