Iowa Blue Cross Blue Shield Wellmark

Please follow the Enrollment Instructions below to become an electronic submitter to Iowa Blue Cross Blue Shield Wellmark.

 

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the BCBS office prior to initiation of electronic claims submission or inquiry.

1. Registration Instructions and Form

If the link above does not work properly, please download this form from:

http://www.wellmark.com/Provider/ClaimsAndPayments/SubmittingClaims.aspx

If you have any questions regarding any of the documents in this package, please call the BCBS EDI Technology Support Center at 1-800-407-0267.

 

Electronic Transaction Registration Form

Section 1

  • Enter your Provider/Business or Group Practice name as the submitter.

  • Enter the Name and Title of the main contact person for your office

  • Enter your phone and fax numbers

  • Enter your demographic information

  • For the question, “ Do you already have a submitter ID?” new applicants please mark “NO”.

  • For the question on whether you provide clearinghouse services, please also mark “NO”.

Section 2

  • For Software Vendor enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our SolAce billing software please call our support line for our SolAce software information.

  • Complete your Provider information on the right side of this section

  • Enter your Tax ID, Group NPI and Individual Provider NPIs

Section 3

  • Either Authorized Signature and Date

 

Signature and Audit Agreement
Please complete the bottom section of this form

 

Provider Authorization for Electronic Transactions VIA Third Party

(For Billing Services ONLY)
If you are a billing service, each of the providers you are billing for must complete this form.

Submitter Change of Address Request Form- Please disregard this form

Cancellation Request-Please disregard this form.

 

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

 

Fax to EC Registration Department at: 800-691-1038

Or email to:
wellmarkecsolutionregistration@hpe.com
 

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

 

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-800-407-0267.

 

Testing

Once you have received your Submitter ID and Password from BCBS, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to BCBS.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.