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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)

Log in to Availity External Link

Don't have an Availity account? Register here External Link.

All network participation forms can be found on the Provider Credentialing page. Or, visit the credentialing Submission Tracker to track the status of your applications, recredentialing submissions and change requests.

*The Blue Cross Blue Shield Global Core program was formerly known as BlueCard Worldwide®

Pharmacy exception requests for non-formulary medications

  • If your patient needs a non-formulary drug, he or she may ask for an exception request. This process may allow coverage for those drugs not included in his or her drug list. To review this process, please visit the CVS Caremark® Prior Authorization External Link page. Your patient also has the option of contacting Wellmark Customer Service at the number printed on the back of his or her ID card.

Drug authorization process

Specialty pharmacy programs

Request for waiver of brand penalty form PDF File

Physical Medicine Treatment Plan (for anticipated services over 20 visits)

Begin the medical authorization process

  • Wellmark Health Plan of Iowa Chiropractic Referral form only PDF File
  • Log in to view Appeals and Inquiries Secure Site information.

    Note: The post-service provider appeal process does not apply to overpayment recovery requests. If you have received an overpayment recovery request and do not agree with our reasons for requesting the refund, submit an overpayment recovery appeal.

    To submit out of network and referral requests, submit an authorization. Please refer to the Jiva quick guide for submitting out of network (OON) requests Secure Site.

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