Blue Ink - Wellmark Blue Cross and Blue Shield

Administration & PolicyAlways use current enrollment,credentialing and contractingdocumentsOnly current versions accepted after July 1Wellmark has various documents for providers to use when requestingparticipation in Wellmark networks and for maintaining demographic andpractice information once approved. It is important that providers use currentversions of applications, the addendum, and supporting documents. Althoughyou may save copies for your convenience, we advise that you update yourcopies at least annually, as Wellmark requires the most current versions.Beginning July 1, 2013, Wellmark will only accept the most current versionof applications, addendums, and contracts. If a noncurrent document issubmitted after July 1, Wellmark will return all documents to the requestorunprocessed with explanation.It is importantthat providers usecurrent versionsof applications,the addendum,and supportingdocuments.Use the Statewide Universal Practitioner/Facility Application when:1. It is the provider’s first time applying for participation; this is true whetherthe provider wants to be listed in the Wellmark directory or not, except forhospital-based providers. (See the Professional Provider Application belowfor additional information.)2. A hospital-based provider is adding a non-hospital-based location with theintent to provide non-hospital-based services.3. A facility or entity wants to provide services eligible for benefitconsideration, but does not want to participate in Wellmark’s networks as aparticipating provider.Use the Professional Provider Application (short application) when:1. The provider is already credentialed with Wellmark and is enrolling at anadditional location, whether under the same or a different tax ID.2. The provider is enrolling with Wellmark as an emergency departmentprovider and practicing as an ED physician.3. A hospital-based provider 1 does not wish to be listed in theWellmark directory.4. A non-credentialed provider wishes to submit claims, but does not wish toparticipate in any networks.A Wellmark addendum is required each time a Universal Application issubmitted. Both documents should be submitted together.Access current application forms, addendums and contracts at Wellmark.com(Provider >Credentialing and Enrollment)1To be considered hospital-based, the provider should practice exclusively at a hospital or afreestanding facility. For details, see the “Contracts and Credentialing” section of the WellmarkProvider Guide at Wellmark.com (Provider > Billing Guides).8 | blueInk April 2013