Provider Inquiry Process - Paper Provider Inquiry Form
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1Provider Inquiry Process
Please submit all your claims and member-related inquiries using one of our secure online tools. Most online inquiries are
answered in one or two business days.
Claim-related Inquiry
Wellmark Member-related Inquiry
General Question
(E.g., corrected claim, denial
(E.g., eligibility, benefits,
review, work comp, etc.)
accumulations, etc.)
Click to open the Ask &
Click to open the Check
Click to open the
Track a Question tool
Check a Claim tool
Member Information tool
Within the secure Check a Claim and Check Member Information Web tools, use the drop-down menu to submit your inquiry.
Most of the claim details and member information will be filled in automatically.
If you have supporting documentation, you can upload up to three attachments to your inquiry.
After submitting your inquiry, you can track the status using the Ask and Track a Question tool.
If you do not have secure access to ,
click
to register. In the meantime you may use the form below and mail it to
Wellmark.
Paper Provider Inquiry Form
Provider Name: __________________________________________ National Provider Identifier: ______________________
Address: ___________________________________________________________________________________________
City: __________________________________________________ State: ___________________ Zip Code: ____________
Contact Name: ______________________________________________ Contact Phone Number: (_____) _____ - ________
Member ID (including alpha prefix): ___________________________________ Federal Employee Program (FEP) Member
Member Name: _____________________________________ Patient Name: _____________________________________
Date(s) of Service: _______________________________________________________ Date of Inquiry: _____/_____/_____
ICN(s): ____________________________________________________________________________________________
Total Charges: _______________________________________________________________________________________
Question details
Attachments
Mail to:
Wellmark Blue Cross and Blue Shield of Iowa
Wellmark Blue Cross and Blue Shield of South Dakota
Provider Service Center*
Provider Service Center
P.O. Box 9232
1601 West Madison St
Des Moines, IA 50306-9232
Sioux Falls, SD 57104
*Indicate FEP on envelope as appropriate.
B-2317949 8/15
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