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Provider Terms and Conditions

By clicking the Accept box below, the individual accessing a interactive web application agrees to the terms and conditions set forth below.

  1. Scope

    These terms and conditions apply to access made available by Wellmark to a interactive web application and all written, visual and oral information to which a party using such application (hereinafter described as a "User") may have access by utilizing a Personal Identification Number(s) (PINs), a Security Password or other security device provided by Wellmark.
  2. Confidentiality Obligation

    All information to which a User has access by utilizing its PIN, Security Password or other security device provided by Wellmark shall be deemed confidential information. Users agree to maintain the confidentiality of such information in accordance with Federal and state laws. In the absence of any such provisions, Users agree to use the same means to protect the confidential information as the Users use to protect confidential information in their own trade or business, but in any event shall at least use reasonable means to protect the confidential information. User agrees that he or she shall only access that information which he or she has a legitimate business need to know. User understands and shall make any individuals who are also provided confidential information obtained through or from a interactive web application aware that access to health claims information in the possession of Wellmark is subject to the confidentiality standards set forth under state and/or Federal law and/or the restrictions for the National Committee for Quality Assurance and that improper disclosure of such information to anyone who does not have a legitimate business need to know the information, may subject the User and or any other individuals who have access to the confidential information to criminal penalties.
  3. Accounts and Security

    Each User shall comply with the following rules:
    1. Account. To access the interactive web application, User must have an account. User can create an account by completing the registration process. User may be required to provide information about User or the Provider as part of the registration process or User's continued access. User agrees that any registration information that User submits to Wellmark will be correct, accurate and up-to-date.
    2. Account Security.
      1. PINs, User Ids, passwords, or other security devices provided by Wellmark shall not be shared with any other individual, except as previously approved in writing by Wellmark's Security Administrator. Passwords shall not be posted or exposed to the view of others and should be constructed in a manner so as to maintain the confidentiality of each authorized individual.
      2. Automatic log on processes, such as PF KEYS or BAT FILES are not to be used unless they require manual input of a PIN, User ID, password or use of any other security device provided by Wellmark.
      3. Passwords should not be saved in the system.
      4. Other rules concerning PINs, User Ids, passwords, or other security devices provided by Wellmark shall be provided to User or to the contact person at the entity to which they are affiliated in writing by the Wellmark Security Administrator (of his or her delegate). User will be subject to certain limitations on access to interactive web applications within these Terms and Conditions or otherwise provided by Wellmark. These limitations are designed to manage the load on the system, promote equitable access, and prevent abuse, and these limitations may be adjusted without notice, as deemed necessary by Wellmark. If Wellmark reasonably believes that User has attempted to exceed or circumvent these limits, User's access to interactive web applications may be temporarily or permanently blocked. Wellmark may monitor User's use of the interactive web applications, for example, to improve access or to ensure compliance with these Terms and Conditions.
      5. User shall ensure at all times that no visual display of any confidential information shall be visible to the general public or unauthorized personnel.
      6. Access to a interactive web application as described in these terms and conditions shall only be available and utilized by authorized individuals which Wellmark's Security Administrator has been notified of in writing, as changes occur and also from time to time. A User's access shall be confirmed in the communication by the Security Administrator to the User or the entity to which they are affiliated. As between Wellmark and the User, Wellmark owns the confidential information provided hereunder and the grant of the limited license to use the confidential information pursuant to this arrangement does not transfer any rights of any kind to the User other than a limited right to use the data in accordance with the security procedures. Further, all materials provided to user and the entity to which they are affiliated by Wellmark regarding the interactive web applications, including instructions or manuals shall remain the sole property of Wellmark and shall be promptly returned upon termination of this agreement.
  4. No Warranty

    Wellmark makes commercially reasonable efforts to maintain the accuracy of the information contained on the interactive web applications. However, the information sources are not always subject to immediate verification, therefore Users should use independent means to verify the information when possible. Accordingly, all confidential information provided by Wellmark is provided "AS IS" and without any warranty, expressed, implied or otherwise.
  5. Access

    Wellmark shall provide access to interactive web applications to User on a basis consistent with other similarly situated Users of the systems. No guarantee of system availability is provided under this arrangement and Wellmark shall not be responsible for any periods of system down time which Wellmark or any entity acting on Wellmark's behalf for web hosting purposes or other maintenance services determines in its sole judgement may require for system maintenance or which occur for any reasons beyond their control.
  6. Audit Rights

    Wellmark may decide to review certain of its Users regarding the use of the interactive web applications by Users and to examine supporting documentation, records and associated information regarding same. Wellmark shall conduct such audits during normal business hours at any premises where functions are being performed and information accessed under this agreement. Users shall cooperate with any such audits.
  7. Notice to Wellmark

    User shall provide notice to Wellmark in the event of: (i) any technical issue that could impact the security, integrity, or performance of Wellmark's systems; (ii) any breach or misuse of any data pulled by User through the API, consistent with state and Federal law which includes the FTC breach notification rule located at External Link; or (iii) any security incident that may impact the security of Wellmark's system or data.
  8. Term and Termination

    These terms and conditions shall be effective upon acceptance and shall continue in force and effect unless the parties mutually agree to terminate or shall terminate immediately upon User's violation(s) of these terms and conditions or any other Security Administration policies communicated to User in writing or electronically.
    1. Wellmark may at an time terminate User's account if:
      1. Wellmark determines that User is (i) in breach of or otherwise acting inconsistently with these Terms and Conditions or (ii) engaging in fraudulent or illegal activities or conduct;
      2. User suffers a data breach or security incident that may impact the security of Wellmark's system, including Wellmark's data;
      3. User's access threatens the security or integrity of the Wellmark systems;
      4. It is determined that User made any false statements as part of User's account registration;
      5. User undergoes a change of control;
      6. A periodic security review determines that User is out of compliance; or
      7. Wellmark determines it is required by law to terminate User's account
    2. Wellmark reserves the right to deny the use of interactive web applications to any person or entity at Wellmark's sole discretion. User acknowledges and agrees that Wellmark may stop providing such access at any time, without notifying User in advance, including, without limitation, for any violation of these Terms and Conditions. If Wellmark disables User's access to User's account, User may be prevented from accessing User's account details or any materials contained in User's account.
  9. Miscellaneous

    1. User acknowledges that the confidential information is a valuable asset of Wellmark's and improper disclosure or use of such information may cause Wellmark irreparable harm and that there may be no adequate remedy available at law. Accordingly, the User agrees that Wellmark shall have the right to obtain immediate injunctive relief to enforce obligations under this agreement in addition to any other rights and remedies Wellmark may have at law or in equity.
    2. Eligibility and benefit information do not constitute authorization of claim payment. These terms and conditions are not intended to supersede any other contract between Wellmark and another party. All other member and provider contractual limitations, including but not limited to, prior approvals, precertification and referrals must be handled separately as defined in the Member and Provider Information offered by Wellmark. Appropriate penalties as defined in those contracts shall apply for failure to meet these obligations.
    3. Any computer hardware and/or software purchased by User to obtain access to or to a interactive web application shall be the sole financial responsibility of User or the entity to which they are affiliated. Wellmark shall not be responsible in any way for any of the software or hardware equipment in the event that this agreement is terminated or the access provided hereunder is otherwise removed or restricted in any way. In addition, User is responsible for ensuring that the hardware and software they have purchased is compatible with any interactive web application. Any costs associated with providing this access, including but not limited to the charges for the ongoing use of telecommunications lines, internet service providers, or the like shall be borne by the User. In addition, Wellmark shall not have any liability whatsoever for any incidental or consequential damages related to providing the access or the use of information under the terms of this agreement.
    4. User represents and warrants that he/she has the authority to access this information on behalf of his/her employer and the authority to agree to these Terms and Conditions. User and his/her employer shall indemnify and hold Wellmark harmless for any loss, cost, or expense, including but not limited to reasonable attorney's fees directly related to the User's improper use of a interactive web application, access to confidential information contained therein, User's release of confidential information to any unauthorized individuals or entities, User's breach or the breach by any of the User's employees, agents or representative of the covenants of this agreement.
    5. To the extent that User is authorized to enter or correct information in one of Wellmark's computer systems via a interactive web application, User agrees that he/she is responsible for the accuracy of any information submitted.
      1. User understands that Wellmark or one of its accounts shall rely upon such information in making decisions related to the administration of health benefit plans such as eligibility determinations and, thus, will use commercially reasonable efforts to ensure the accuracy of the information provided. User further understands that changes made to membership information such as date of birth corrections or address changes may cause Wellmark to make changes to premium rates at the next billing cycle or renewal date.
      2. User understand that Wellmark or one of its subsidiaries or Affiliates shall rely upon such information in making decisions related to the credentialing and recredentialing of healthcare providers in Wellmark's provider networks. User further understands that changes made to credentialing and/or recredentialing information may cause Wellmark to remove a provider from Wellmark's provider networks. User is only responsible for the provider locations governed by the User.
    6. If any provision of this agreement should become prohibited by or irrelevant by applicable state or Federal law or determined invalid or unenforceable by a court of competent jurisdiction or any other governmental or regulatory authority with jurisdiction over the parties hereto such provisions shall be ineffective to the extent of such prohibition, without invalidating the remainder of the provision or remaining provisions of this agreement. Any notice provision requiring a written notice shall be satisfied if notice is provided electronically to the designated security coordinator and/o credentialing security coordinator on behalf of their employer named in the Provider Agreement or Web Access Agreement, online web registration or to Security Administration on behalf of Wellmark.
    7. The confidentiality obligations and the indemnification obligations shall survive the termination of this agreement.
    8. These Terms and Conditions shall be construed according to the laws of the State of Iowa.