Wellmark
Annual Provider Payment Update
Effective for dates of service on and after July 1, 2022.
If you do not have access to the secure Provider Portal, take one of the following steps:
1. If your taxpayer identification number (TIN) is not registered, select “Register now” on the provider page at Wellmark.com.
2. If your TIN is registered and you want to expand or change your user access, contact your office’s designated security coordinator (DSC).
Updated Provider Experience
Wellmark Blue Cross and Blue Shield enhanced their
public provider experience. Because the provider site is your go-to resource for doing business with Wellmark, delivering a first-rate user experience is a top priority. The goal of the new site is to streamline your experience by making it easier to find the resources you need. The URLs have been updated with this change. This means you will need to update your Wellmark provider portal bookmarks and embedded links. Doing so will prevent providers from getting any error or experiencing any issues with their systems. NOTE: the secure
Provider Portal will not be undergoing any updates at this time.
Understanding Wellmark Blue Cross and Blue Shield Remittance Information
Wellmark commercial and out-of-state member’s BCBS plan remittance information Participating providers have two options for reviewing payment information on Wellmark claims:
1. Electronic remittance advice (ERA), also known as the 835, is the electronic transaction that provides claim payment information. Wellmark uses Availity® to transmit these files to providers and clearinghouses.
a. To receive electronic payment information on Wellmark claims, new participating
providers must register for ERAs with Availity after receiving a welcome letter.
2. Provider claim remittance (PCR) are posted on the Wellmark provider portal and are similar to the member’s explanation of benefits (EOB).
Wellmark Advantage Health Plan® remittance information
Participating providers have two options for reviewing payment information on Wellmark Advantage claims:
1. Electronic remittance advice (ERA), also known as the 835, is the electronic transaction that provides claim payment information. Wellmark uses Availity to transmit these files to providers and their clearinghouses in the same manner as commercial business.
2. Explanation of payment (EOP) are available on the new Wellmark Advantage provider portal. These are similar to the member’s explanation of benefits (EOB).
Steps to access Medicare Advantage EOPs:
— Select Check MA claims in the Wellmark provider portal to launch the Medicare Advantage portal
— Select Check Claim Status from top navigation
— Enter a claim number or member ID* and select search — After a claim number populates, select the claim.
— Claim details will populate, at the bottom of the screen select View Explanation of Payment (EOP)
* Providers will need to input any member or claim ID they expect to see an EOP for vs. utilizing a date range. This differs from the commercial process.
Follow-up processes for missing remittance information
Wellmark strives to deliver remittance information as early as possible each week. On the occasion the remittances do not appear at the expected time, follow these steps to troubleshoot. If you receive electronic remittance advice (ERA):
1. Allow 72 hours for the ERA to arrive. Each week a few files may fail the electronic transactions. Wellmark works to restore these files as soon as possible.
2. If ERA still does not arrive after 72 hours, reach out to your clearinghouse to confirm whether they received the ERA from Wellmark’s clearinghouse, Availity.
a. If your clearinghouse has not received the ERA, the clearinghouse should open a ticket with Availity by calling 1-800-282-4548.
b. Availity will work with Wellmark Technical Support to determine any issues with ERAs.
3. If issues persist, providers may directly open a ticket with Wellmark Technical Support at (800) 407-0267.
4. If you leverage Provider Claim Remittances(PCR) and you do not see them on the provider portal by end of business on Monday follow these steps to troubleshoot: a. Allow 92 hours and then contact Wellmark Technical Support right away at (800) 407-0267.
It is important that providers distinguish between ERA and PCR when calling in for support.
Understanding the Importance of Recredentialing
Learn about the recredentialing process
What is recredentialing?
Practitioners, facilities, and entities are required to be recredentialed every 36 months from the initial application acceptance date, for all Wellmark networks. Recredentialing is a critical step providers must take to help avoid negative consequences. These negative consequences can include:
• Termination from Wellmark networks
• Removal from the Provider Directory
• Claim denials or payment as out-of-network
• Inability for members to select provider as a primary care practitioner (PCP)
How are contracted providers notified about recredentialing?
Approximately four months prior to a provider’s recredentialing due date, the first recredentialing notification is sent to all credentialing contact email addresses that Wellmark has on file for the provider. Please note that only one recredentialing application is required. The second notification is sent three months before the recredentialing deadline, and the final notification is sent two months before the recredentialing deadline. Providers that do not respond after the final notification will be terminated 60 days after the final notification is sent.
How do I complete recredentialing?
Once the recredentialing notification is received, log in to
E-cred Central and click on the Recredentialing Tool. You will be led through the application, which consists of answering a series of questions.