Claims

Claims and billing

Wellmark Advantage^SM Claims Filing Guide

Provider Manual – find detailed information on eligibility, reimbursement, billing, utilization management, appeals and more.

Plan benefit policy papers

Understand how Wellmark Advantage Health Plan benefits offer enhancements beyond Original Medicare. This also includes information on conditions for payment and member cost share.

• Annual physical examination
  • Blue Medicare Advantage PPO, Enhanced PPO, Classic PPO and Valor PPO
• Blood and blood components
  • Blue Medicare Advantage PPO, Enhanced PPO, Classic PPO and Valor PPO
• Chiropractic care
  • Iowa Blue Medicare Advantage PPO and Valor PPO
• Dental benefits
  • Iowa Blue Medicare Advantage PPO and Valor PPO
  • South Dakota Blue Medicare Advantage Enhanced PPO, Classic PPO and Valor PPO
• Fitness benefits
  • Blue Medicare Advantage Valor PPO
• Home infusion therapy
  • Blue Medicare Advantage PPO, Enhanced PPO, Classic PPO and Valor PPO
• Over-the-counter
  • Blue Medicare Advantage Valor PPO
• Skilled nursing facility
  • Blue Medicare Advantage PPO, Enhanced PPO, Classic PPO and Valor PPO
• Vision services
  • Blue Medicare Advantage PPO, Enhanced PPO, Classic PPO and Valor PPO
• Worldwide emergency and urgent care
  • Blue Medicare Advantage PPO, Enhanced PPO, Classic PPO and Valor PPO