E-CREDENTIALING CENTRAL USER GUIDE · 2018. 5. 11. · This User Guide provides an overv iew of E-credentialing (E-cred) Central, explains how to use the E-cred Central tools to submit

Confidential and Proprietary – Wellmark Blue Cross and Blue Shield May 2018

E-CREDENTIALING CENTRAL

USER GUIDE

WELLMARK NETWORK ADMINISTRATION

Updated: May 2018

CONTENTS

1 Introduction 14 Application Tool 25 Change Request Tool 52 Recredentialing Tool 61 Provider Directory

Validation Tool 67 Submission History Tool 69 View My Organization

1 Confidential and Proprietary – Wellmark Blue Cross and Blue Shield May 2018

About this Guide This User Guide provides an overview of E-credentialing (E-cred) Central, explains how to use the E-cred Central tools to submit applications, change requests, complete directory validation requests, and recredentialing requests, as well as how to search and view submissions, manage user security, and view the list of providers in your organization through E-cred Central.

What is E-cred Central? E-cred Central is a paperless solution to help all providers submit credentialing and non-participating applications, recredentialing requests, change requests, and complete directory validation requests. The E-cred Central tools were developed by Wellmark’s Network Administration team to meet the unique needs of providers in Iowa and South Dakota.

E-cred Central Terminology

Term Definition Organization One or more tax identification numbers (TINs) [and associated national provider

identifiers (NPIs)] that are tied together by either a group or direct contractual relationship with Wellmark. Please note, a TIN may not belong to more than one active organization at a time; however, an NPI can belong to multiple TINs - some of which may be under other organizations.

Organizational Security Coordinator (OSC)

Individual who has been granted authority by the organization to manage the TINs, the associated NPIs, and user security for your organization for the purposes of credentialing, recredentialing, change requests, and completion of directory validation requests using E-cred Central. This includes delegated entities.

Backup OSC Individual with the same rights and responsibilities as the primary OSC and who can access E-cred Central in cases where the primary OSC is unavailable.

Users Non-OSC individuals that are invited by the primary or backup OSC to use E-cred Central. They will have the ability to complete credentialing, recredentialing, and change requests. Users can be granted full or limited access to the organization. The OSC or backup OSC can modify a user’s access at any time by using Manage My Users.

Introduction

Get Started


Guest User Individual who has been granted limited access to E-cred Central to submit an application to Wellmark. A Guest User will be able to access the Application Tool, Submission Status Tracker, Submission History Tool, View My Organization and the Manage My Users tool.

Full User Individual who has been granted unlimited access to E-cred Central to use applicable tools. A Full User’s access to tools in E-cred Central will be determined by the application that was submitted and processed to be a participating provider or a non-participating provider in Wellmark Networks.

Secure Access An important feature of E-cred Central is that security is arranged on an organizational level. Unlike Wellmark’s other security model that requires separate login credentials for each TIN, E-cred Central combines all TINs into one organization that have the same signatory name on Wellmark agreements. If you need access to the E-cred Central tools, please remember that the OSC serves all users within your organization, not just those associated with your TIN. In addition, E-cred Central credentials (username and password) is separate and unique from secure access for applications such as the Check Member Information and Check a Claim tools on Wellmark.com. All users, including the primary and backup OSC, must create a unique user ID for E-cred Central.

WHY IS A BACKUP OSC REQUIRED? A backup OSC is required in the event that a primary OSC would leave the organization or becomes

unavailable to manage E-cred Central. The backup OSC can fulfill the role of ensuring access, and the submission history will be retained for the organization


Organizational Security Coordinator (OSC) Registration To access E-cred Central for your organization, please begin by registering as the primary OSC for your organization. This role gives you the responsibility of managing security for all users in your organization for the purposes of credentialing, recredentialing, change requests, and completion of directory validation requests in E-cred Central. Note: You will be required to register a backup OSC. For the backup OSC you will need the name, phone, and email address in order to complete your registration.

STEPS TO COMPLETE: STEP 1: REGISTER YOURSELF AS PRIMARY OSC Enter your first name, last name, phone number, email address and TIN (do not include hyphen). Click Continue.

If the TIN you entered is associated with an organization with multiple TINs, then you will be prompted to enter a second TIN for security purposes.

If the TIN you entered already has a registration completed, you will receive the following message:


Review your entries. Click Change to update or Continue to proceed.

Read and accept the terms and conditions.

Enter a unique user ID and password that will be used exclusively to log in to E-cred Central. Select your secret question and enter the secret question answer. Click Continue.


Review your entries. Click Change to update or Continue to proceed.

STEP 2: REGISTER THE BACKUP OSC Enter the backup OSC’s name, phone number, and email address. Click Continue.


Review your entry. Click Change to update or Continue to proceed.

The OSC will receive a confirmation email and the backup OSC will receive an email invitation to E-cred Central.

Confirmation email sent to primary OSC:

From: [email protected] [mailto:[email protected]] Sent: To: Cc: Subject: Registration for E-credentialing Central Tool Complete – DO NOT REPLY Dear _____________, Thank you for registering for E-credentialing Central. You now have secure access to all available E-cred tools. For technical assistance, please call Electronic Commerce (EC) Solutions at 1-800-407-0267. Sincerely, Wellmark Network Administration

Invitation email sent to backup OSC:

From: [email protected] [mailto:[email protected]] Sent: To: Cc: Subject: Registration for E-credentialing Central Tool Complete – DO NOT REPLY Dear ___________,

Your Wellmark Organizational Security Coordinator, , has invited you to start using Wellmark E-credentialing Central. This online solution will help you efficiently manage your provider's credentialing and contracting information.

To log in, please complete your registration within 14 days of this invitation. You will be asked to create a user ID and password.

These security credentials will be different from those you use to access other content on Wellmark.com. Even if you already use certain claims- and member-related tools, you will need to register separately to access Wellmark E-credentialing Central.

Questions? Please contact your organizational security coordinator.

Sincerely, Wellmark Network Administration


OSC Responsibilities

Backup OSC Registration Organizations registered with E-cred Central are required to have one primary and one backup OSC. The primary OSC will enter the backup OSC information for someone in the organization other than the primary OSC. After the OSC has entered the backup OSC’s name and email address, that individual will receive an email invitation to complete the registration process for E-cred Central. The backup OSC will enter a user ID, password, secret question, and secret question answer. In addition, as a backup OSC he or she has the ability to manage the TIN(s) and NPI(s) that are assigned to the individual by their OSC. To view the list of TINs the backup OSC has access to, the backup OSC can click on View List as indicated in the screenshot below.

The individual will have 14 days from the date of the invitation email to create a user ID and password. If the timeframe expires, the OSC can resend the invite without having to recreate an invitation for 90 days. User Registration Primary and backup OSC will both have authority to invite users through Manage My Users.

Similar to the backup OSC, users will be sent an email invitation to complete the registration process to access E-cred Central.


Invitation email sent to user: From: [email protected] [mailto:[email protected]] Sent: To: Cc: Subject: Registration for E-credentialing Central Tool Complete – DO NOT REPLY

Dear ___________,

Your Wellmark Organizational Security Coordinator, , has invited you to start using Wellmark E-credentialing Central. This online solution will help you efficiently manage your provider's credentialing and contracting information.

To log in, please complete your registration within 14 days of this invitation. You will be asked to create a user ID and password.

These security credentials will be different from those you use to access other content on Wellmark.com. Even if you already use certain claims- and member-related tools, you will need to register separately to access Wellmark E-credentialing Central.

Questions? Please contact your organizational security coordinator.

Sincerely, Wellmark Network Administration

The invited user will have 14 days from the date of the invitation email to create a unique user ID and password. If the timeframe expires, the OSC or backup OSC can resend invitation without having to recreate a new invitation for 90 days. If the invited user has not completed the registration within 90 days, the user will be deleted and the primary or backup OSC will need to create the user again.

Maintaining Access The primary OSC and backup OSC must verify or update his/her email address every 60 days. A pop-up reminder to complete this task will appear when these individuals log in to E-cred Central. In addition, either the OSC or backup OSC must log in at least once every 90 days to maintain their organization’s access to E-cred Central. Failure to do so will result in the suspension and eventual termination of the organization’s access and deletion of the organization’s submission history. The 90-day login requirement is based on calendar days and will start from the day the OSC registration is complete or the date of the last login by either the primary or backup OSC.

• After 90 days, both the primary and backup OSC will be sent a warning email. • At 100 days a second warning email is sent. • At 130 days the organization is disabled. • At 180 days the registration is deleted.

If your organization’s access has been disabled, please contact Web Security at [email protected] to have the account reactivated. In the event the registration is completely deleted, you will need to re-register. The entire submission history for your organization will be removed along with the access for all users.

mailto:[email protected]


Once the OSC registration process is complete, if you have a new TIN that does not exist with Wellmark, you will be granted limited access to E-cred Central as a Guest User. As a Guest User, you will be able to access the Application Tool, Submission Status Tracker, Submission History Tool, View My Organization and the Manage My Users Tool.

Guest User View

If the TIN you entered did not exist with Wellmark, when the application has completed processing, the Guest User account will automatically be switched to a Full User account in E-cred Central. If the TIN you entered in the OSC registration already exists with Wellmark you will be granted access as a Full User to E-cred Central. The tools you have access to in E-cred Central will be determined based on the application that you submitted and was processed to be a participating provider or a non-participating provider in Wellmark networks.

Full User View - Participating Provider


Full User View - Non-Participating Provider

Technical Support Contact EC Solutions at 1-800-407-0267. Non-Technical Support Email Provider Credentialing.

Support

https://www.wellmark.com/AboutWellmark/ContactUs/Contact_ProviderEmail.asp


Wellmark E-cred Central is a set of Web-based tools designed specifically for providers, to make doing business with Wellmark easier and more efficient. E-cred Central is a completely electronic means of submitting credentialing and non-participating applications, provider change requests, and recredentialing submissions. Within each tool there are a series of questions to answer to help ensure all necessary information is submitted, and you have the ability to review the selections you make as you go through the process. Full Access Users have the ability to submit applications, change requests, recredentialing submissions, check the status and review submissions, view your organization, and manage users (for OSCs only). Guest Users have the ability to submit applications, check the status and review submissions, view your organization, and manage users (for OSCs only).

Logging in to E-cred Central Log in to E-cred Central by entering in your unique E-cred Central user ID and password by clicking on the provider tab located on Wellmark.com.

Logging out of E-cred Central Click on the Menu ( ) icon in the top right corner of your screen and select Logout.

E-credentialing Central Overview


Note: This view is for a participating provider.

APPLICATION TOOL Apply to join a network, add a practice location, finish an application, or apply to submit claims as a non-participating provider. CHANGE REQUEST TOOL Submit requests to have provider information updated. RECREDENTIALING TOOL Submit recredentialing applications online and receive notifications by email when recredentialing is due. PROVIDER DIRECTORY VALIDATION TOOL Validate the accuracy of the provider information displayed in Wellmark’s Provider Directory. SUBMISSION STATUS TRACKER Check the status of provider credentialing and recredentialing applications, and provider change requests. SUBMISSION HISTORY TOOL Review history of all requests submitted through E-cred Central (120 days).

VIEW MY ORGANIZATION Provides a list of all TINs and NPIs associated with the organization. MANAGE MY USERS Only available to OSCs. Provides the OSC the ability to invite individuals as users of E-cred Central and edit their access.

WHAT’S THIS?

The menu icon in the upper right hand corner of E-cred Central allows users to navigate to the E-cred Central home screen, Application Tool, Change Request Tool, Recredentialing Tool, Provider Directory Validation Took, Submission History Tool, User Guide, or log out of E-cred Central.


E-cred Central Icons

Icon What it means Collapsed Click this icon to collapse the information.

Expanded Click this icon to expand the information.

Date Picker Click this icon to launch a calendar to select an effective date.

Help Hover over this icon to get more information.

Menu Click this icon to go back to the lobby or log out.

Remove Click this icon to remove information.

Completed Sections The right hand side of the tool will display the completed sections with checkmarks.

Show Details Click the Show Details link to display the details of your current selection(s).

Show All If you selected more than three providers, click the Show All link to display all providers selected. De-Select All Click De-Select All to remove all of your selections.

Auto-Save Your application will be automatically saved in sections where this icon appears. Only appears in the Application Tool.


Navigation The Application Tool is the online tool used to submit an application to be a participating or non-participating provider in Wellmark Networks. In the Application Tool lobby you can begin an application, finish an application you’ve already started, or resubmit an application not processed due to missing information.

How to Apply The following steps should be completed to submit an application for practitioners to apply as participating or non-participating and to add an additional practice location. The Application Tool in E-cred Central replaces the need to submit the Wellmark, Inc. Additional Location or Hospital-Based application, the Iowa Statewide Universal Practitioner Credentialing application, the Iowa Statewide Universal Facility Credentialing Application, and the Wellmark, Inc. Practitioner Non-Participating application, and the Wellmark, Inc. Facility and Entity Non-Participating Application.

Practitioner Participating Application 1. Click on “Begin an application” from the Application Tool lobby. 2. Select Practitioner, then select “I want to apply to credential with and participate

in Wellmark Network(s) as a participating provider.”

3. Select a TIN from the list provided. If the TIN is not listed, click “My TIN is not listed” and enter the TIN. Note: If the organization only has one TIN, you would not see this screen.

TIN

Application Tool


4. Select the practitioner from the drop down box. If you are not listed, select “The practitioner I’m adding is not listed” and enter the provider NPI.

PRACTITIONER 5. If applicable, you will be asked if the provider will be practicing as a Hospital-

Based Practitioner at the practice location(s) you are adding. Select “Yes” or “No.” HOSPITAL BASED APPLICATION

6. Answer the questions listed. If you answer “yes” to any of the questions, you will receive a popup indicating that the provider does not meet the credentialing and contracting criteria to participate in Wellmark’s networks. You may then apply as a non-participating provider.

DOING BUSINESS WITH WELLMARK

7. Review the language regarding progress, saving your work, and uploading supporting document. If you have read and understood the information, check the box.

BEFORE YOU CONTINUE

8. If the provider’s degree auto populates, then review the provider’s degree and check whether the information is current and correct or if there is a different degree. If it does not auto populate, E-cred Central will provide a drop down list for you to pick the provider’s degree. In order to participate in Wellmark Networks, you must be an approved provider type. Please see chapter 3 of the “Credentialing and Network Participation” section of the Provider Guide.

Note: This is the first point in the application process where your application will automatically be saved. Each time you see the save icon your application will be automatically saved.

DEGREE

9. If applicable, you will be asked to pick from a drop down box the language(s) spoken by the practitioner. English is a default value and cannot be removed. You may add additional language(s).

LANGUAGE(S) SPOKEN

10. Select the practice location for the practitioner. If the practice location is not on the list, click “The Practice location isn’t on this list. I would like to enter a different practice location” and enter the practice location. If you have multiple practice locations for the practitioner, you will need to enter each practice location one at a time.

PRACTICE LOCATION

11. Enter the date the provider will be starting at this location and scheduling phone number for the location.

PRACTICE LOCATION START DATE AND SCHEDULING PHONE NUMBER

12. Answer the practice location requirements questions. Answer these questions for each new practice location. For each “no” response, an explanation is required.

PRACTICE LOCATION REQUIREMENTS

13. If applicable, select the primary medical specialty for the practitioner for the practice location. If applicable, also select the secondary medical specialty.

MEDICAL SPECIALTY

14. If applicable, answer the practice focus questions. PRACTICE FOCUS

https://www.wellmark.com/Provider/CommunicationAndResources/PDFs/S5780_ContractsandCredentialingProviderGuide.pdf


15. Select “Yes” or “No” if you are accepting new patients at this practice location and if you have age limitations at this practice location.

ACCEPTING NEW PATIENTS AND AGE LIMITATIONS

16. Enter the credentialing and notification contact information. CREDENTIALING AND NOTIFICATION CONTACT INFORMATION

17. Enter the billing information that will be used at the practice location. BILLING INFORMATION

18. If applicable, E-cred Central may ask you to verify the provider’s practice location information. On this screen, you may edit and also add other practice locations for the provider.

YOUR ADDRESSES

19. If applicable, E-cred Central will ask you to enter the email address for the person who will validate your information as it appears in Wellmark’s Provider Directory.

PROVIDER DIRECTORY VALIDATION EMAIL ADDRESS

20. If applicable, E-cred Central may take you to a screen to review the information that displays to ensure all information you want to submit to Wellmark is captured. On this screen, you will also have the ability to provide additional practice locations.

PRACTICE LOCATION REVIEW

21. The provider’s current board certifications or other certifications will display. On this step you will have the opportunity to update the expiration date, add another board certification or other certification, or move on to the next step. If applicable, E-cred Central will ask you to enter Board Certifications or Other Certifications. If you have no Board Certifications or Other Certifications, you may check that box.

BOARD CERTIFICATIONS OR OTHER CERTIFICATIONS

22. The provider’s current state licenses will display. On this step you will have the opportunity to update the expiration date, add another license, or move on to the next step. If you are applying as a new participating provider, you will be asked to fill out your License information. If you are an existing provider and your current license is expiring, you will need to update your expiration date. If you do not update the expiration date, you will be prompted and required to explain why the license is expiring.

LICENSES


23. If you are already with Wellmark, your current registrations, certifications, or endorsements will display. On this step you will have the opportunity to add another certification, update the expiration date, or continue to the next step. If you are a new provider applying to be participating, if applicable, you will be prompted by E-cred Central to enter a DEA or CSR registration. If you do not have a DEA/CSR but have a practitioner who prescribes on your behalf you may check the box. You will have the chance to add a new referring physician or physician group, who can prescribe on your behalf.

To enter additional registrations, You may click the “ADD” box and repeat the process.

REGISTRATIONS, CERTIFICATIONS OR ENDORSEMENTS

24. If applicable you will be asked on the next screen to enter admitting privileges.

HOSPITAL ADMITTING PRIVILEGES

25. Enter your malpractice coverage information. Click the ‘Add’ button to save the malpractice information you entered. You may add additional malpractice coverage by repeating process.

MALPRACTICE COVERAGE

26. On this next screen, you will be asked to enter your Medical or Professional Degree(s). Click the ‘Enter’ Box to add your Degree. You may repeat the process to add another Degree.

MEDICAL DEGREE

27. This screen will ask you complete the information about your residency training. Click on the ‘Enter’ box to save the information you entered. You may add additional residency by repeating the process.

RESIDENCY TRAINING

28. Fill out the information boxes about your professional work history. You are required to provide professional work history for the past 5 years. If you have been licensed under 5 years, submit your professional work history for the duration of your current license. You may enter up to 20 locations.

PROFESSIONAL WORK HISTORY

29. You will need to answer ‘Yes’ or ‘No’ to the following Quality Focus questions. For each ‘Yes’ response an explanation is required.

QUALITY FOCUS 30. Upload required documentation. The tool will indicate what documentation is

required to be submitted. UPLOAD DOCUMENTATION

31. Review and confirm your selections. If you find something that you need to correct, use the “Go Back” button to return to the appropriate screen.

CONFIRM 32. Review and attest to the information you submitted by checking the box and

providing the provider’s name, not the submitter’s name.

IMPORTANT By completing this step you are attesting that all the information supplied in

this application is accurate and that you have the authority to attest on the provider’s behalf.

PROVIDER’S RIGHTS AND ATTESTATION


Practitioner Non-Participating Application

1. Click on “Begin an application” from the Application Tool lobby. 2. Select Practitioner, then select “I want to submit claims for services provided to

Wellmark members as a non-participating provider.”

TYPE OF APPLICATION

3. Select a TIN from the list provided. If your TIN is not listed, click “My TIN is not listed” and enter your TIN.

TIN 4. Select your NPI from the dropdown box. If not listed, click “The practitioner I’m

adding is not listed” and enter the practitioner’s NPI. NPI

5. The next screen will ask if you will be practicing as a Hospital-Based Practitioner at the practice location(s) you’re adding. Select “Yes” or “No.” Additionally, you will need to fill in the Practitioner Information. Note: You may enter the practitioner’s full Social Security number or the last 4 digits.

PRACTITIONER INFORMATION

6. Answer the questions listed in this next screen. Select “Yes” or “No”. DOING BUSINESS WITH WELLMARK


BEFORE YOU CONTINUE

8. Select the practitioner’s degree from the drop down box. If you do not see the degree in this list, you may click that option and E-cred Central will allow you to free type your degree.

Note: This is the first point in the application process where your application will automatically be saved. Each time you see the save icon your application will be automatically saved.

DEGREE

9. Select the practice location for the practitioner. If the practice location is not on the list, click “The Practice location isn’t on this list. I would like to enter a different practice location” and enter the practice location. If you have multiple practice locations for the practitioner, you will need to enter practice location one at a time.

PRACTICE LOCATION


10. On the next screen, enter the practice location start date and scheduling phone number.


11. On this next screen, type your medical specialty at this practice location. If applicable, you may select a secondary medical specialty.

MEDICAL SPECIALTY 12. Please enter the notification contact information for this new practice location. Fill

out the Notification contact email address, name, and phone number. NOTIFICATION CONTACT INFORMATION

13. On this screen, please enter the billing NPI. If you are billing as a clinic or group, use the organizational NPI otherwise use you’re rendering NPI. Select where paper checks should be sent and fill in your billing contact email address and phone number.

BILLING INFORMATION

14. Verify the practice location originally entered at the beginning of the application, At this point, you have the option to add other practice locations or click “I’m finished adding and reviewing practice locations.”

YOUR ADDRESSES

15. Enter your license(s) information. If you use the ‘ADD’ button to add more than one license. When you are done adding license(s), you would click “I’m finished adding licenses.”

LICENSES

16. Upload required documentation. The tool will indicate what documentation is required to be submitted. Note: File size is limited to 10 MB.

UPLOAD DOCUMENTATION


CONFIRM

18. Review and attest to the information you submitted by checking the box and providing the provider’s name, not the submitter’s name.





Facility and Entity Participating Application 1. Click on “Begin an application” from the Application Tool lobby. 2. Select Facility/Entity, then select “I want to apply to credential with and participate

in Wellmark network(s) as a participating provider.”

TYPE OF APPLICATION

3. Select a TIN from the list provided. If your TIN is not listed, click “My TIN is not listed” and enter your TIN. Note: If your organization only has one TIN, you would not see this screen. Select if you are doing business under any other name.

TIN

4. Please enter the Facility/Entity’s NPI. NPI 5. Enter the Facility/Entity Name. Answer if this application is a result of an ownership

change. If you answer ‘Yes’, please enter the ownership change information. FACILITY/ENTITY INFORMATION


BEFORE YOU CONTINUE

7. Select the Facility/Entity Type from the drop down box.

FACILITY/ENTITY TYPE

8. On this next screen, enter the Practice Location Name, Address, and phone number(s).

PRACTICE LOCATION

9. On the next screen, enter the practice location start date and scheduling phone number.


10. Provider the Credentialing contact email address, contact name and phone number. Also enter the notification contact information for this location and the email address for the person who will validate your information as it appears in Wellmark’s Provider Directory.

CREDENTIALING AND NOTIFICATION CONTACT INFORMATION

11. On this next screen, please enter the billing NPI to be used for billing. Fill out all payment information.

BILLING INFORMATION


12. Verify the practice location originally entered at the beginning of the application and then you have the option to add other practice locations.


13. Enter Applicable Accreditation or Other Certifications for the Facility/Entity. Click ‘ADD’ to save each Accreditation or Certification. You may repeat the process to add more than one Accreditation or Certification. Note: For information regarding which Facilities/Entities are required to have Accreditations or other Certifications, see the “Credentialing and Network Participation” section of the Provider Guide.

ACCREDITATION AND OTHER CERTIFICATION

14. Enter the Facility/Entities Malpractice Coverage information. Click ‘ADD’ to save the information entered before moving on. You may repeat this process to add another malpractice coverage.

MALPRACTICE COVERAGE

15. On the next screen, answer the quality focus questions for the Facility/Entity. If you answer ‘Yes’ to either question, you will need to provide an explanation.

QUALITY FOCUS 16. Answer any additional questions on the next screen, such as the Medical Director’s

information. ADDITIONAL QUESTIONS




CONFIRM





https://www.wellmark.com/Provider/CommunicationAndResources/PDFs/S5780_ContractsandCredentialingProviderGuide.pdf


Facility and Entity Non-Participating Application 1. Click on “Begin an application” from the Application Tool lobby. 2. Select Facility/Entity, then select “I want to submit claims for services provided to

Wellmark members as a non-participating provider.”

TYPE OF APPLICATION

3. Select a TIN from the list provided. If your TIN is not listed, click “My TIN is not listed” and enter your TIN. Note: If your organization only has one TIN, you would not see this screen. Select if you are doing business under any other name.

TIN

4. Enter the Facility/Entity’s NPI. NPI 5. Enter the Facility/Entity Name. Answer if this application is a result of an ownership

change. If you answer ‘Yes’, please enter the ownership change information. FACILITY/ENTITY INFORMATION


BEFORE YOU CONTINUE

7. Select the Facility/Entity Type from the drop down box.

FACILITY/ENTITY TYPE

8. On this next screen, enter the Practice Location Name, Address, and phone number(s).

PRACTICE LOCATION 9. Enter the practice location start date and phone number(s). PRACTICE LOCATION

START DATE AND SCHEDULING PHONE NUMBER

10. Fill out the Notification contact email address, name, and phone number. NOTIFICATION CONTACT INFORMATION

11. On this screen, please enter the billing NPI to be used for billing. Fill out all payment information.

BILLING INFORMATION

12. Verify the practice location originally entered at the beginning of the application and then you have the option to add other practice locations.



13. If applicable, enter the Facility/Entity license(s) information. If not required to be licensed for the services your facility/entity provides check ‘no’.

LICENSES 14. If applicable, you will be asked on this screen if you see patients that are Medicare

eligible. If you answer ‘Yes’, you will be asked to provider the Medicare Certification Number.

ADDITIONAL QUESTIONS




CONFIRM



this application is accurate and that you have the authority to attest on the practitioner’s behalf.


Application Returned for Missing Information If your application is returned for missing information, an email will be sent to the email address associated with the submitter, indicating that the application was returned. If you receive this email, you will need to return to the Application Tool, type your correction in the “Missing Information” section, complete the attestation, and click “Submit.” The application must be corrected and resubmitted within 30 days from the date it was returned. To access the returned application, click on the “Resubmit an application not processed due to missing information” link within the Application Tool. Then, find the application you need to correct and click the “Open Application” button.


You will be redirected to the “Submission Detail” page. On that page, scroll down to the “Missing Information” section. This section will identify what needs to be corrected. You will need to read the note, type in your correction, complete the attestation, and click “Submit.”


Overview The Change Request Tool is the definitive online tool to submit requests to have information updated such as address change, address cancel, TIN change, specialty change, or email address change. Once a change request has been submitted it will automatically be sent to Wellmark for review and completion.

Navigation There are 15 types of changes that can be submitted using the Change Request Tool. For each change request type there are a series of steps to complete. The provider data will be displayed to you (e.g., provider name, address, etc.) which means less manual entry for you. The right hand side of the screen will display the steps that have been completed and in the end users will have the chance to review the changes before submitting it to Wellmark. All fields are required, unless otherwise indicated throughout the tool. Pop-up messages and/or red errors will appear if information is not entered and you will not be allowed to move forward in the tool. The screenshots and information on the next page describe the general navigation that will occur throughout the Change Request Tool. The step-by-step instructions and details for each change can be found later in this section.

IMPORTANT Do not type the provider information in all

CAPS. Some of the information entered in the Change Request Tool will be automatically imported into Wellmark’s database. Therefore, if the data is entered is in all CAPS, this is the way the data will appear in Wellmark’s systems and viewable back to you within E-cred Central.

Change Request Tool


For each type of change, the TINs that users have access to will automatically populate in the first step. If you have only one TIN associated with your organization, the “Select TIN” step will be automatically skipped. Users can either select one TIN from the list by clicking on it or enter a TIN and click Select. The TIN selected will appear in the right hand panel under “Your Current Selection.” As you move throughout the tool, your selection(s) will move to the right panel.

If you would like to change the selection, simply click on the “ ” icon to remove the TIN and then reselect the correct TIN. At any time you will have the ability to go back to the previous step to make changes. Once you are ready to proceed, click Continue.

You have the ability to review the details of your selections at any time. Select the Show Details link and the details of your selections will display.


Before submitting the change to Wellmark you will have the ability to review and confirm your selections.

If changes need to be made to your submission, click the Go back button prior to submitting, otherwise select Confirm.

IMPORTANT If you use the Go Back button,

the information you submitted prior to going back will not be retained.


The final step to complete for all change requests is to attest to the information entered. By attesting, you are stating you have authorization to submit the information on behalf of the provider. Click the check box and enter in your name on the signature line. The date will automatically populate with the date of submission. At the bottom of the page there will be a checkbox for an email confirming your submission. This is defaulted as checked and will go to the email address associated with the account.

Once you have provided your signature, click Submit and your submission will be automatically sent to Wellmark for processing. The details of your submission will display and can be uploaded to a PDF to be printed. From here you can either go to the Submission Status Tracker to track the status of your submission, go to the Submission History Tool, or return to the main menu.

If you indicated you would like an email confirmation of your submission you will receive an email with your submission number. This E-cred submission number can be used within the Submission History Tool or the Submission Status Tracker to view the details of your submission.

http://www.wellmark.com/Provider/CredentialingAndEnrollment/SubmissionTracker.aspxhttp://www.wellmark.com/Provider/CredentialingAndEnrollment/SubmissionTracker.aspx


Types of Requests

WHAT’S THIS?

Hovering over the orange question mark will provide a description for each change request type.


Change Request Type Description Accepting New Patients Or Age Limitations Change

Change information for accepting new patients or change age limitations for one or more practitioners at a practice location.

Address Update Cancel, change or add a practice location address. Admitting Privileges Change Change the admitting privileges for one or more practitioners.

Backup Provider Change Change practitioner backup information for one or more practitioners at a practice location.

Board Certification Or Accreditation Change Change Certifications or Accreditations for one or more providers at all practice locations.

Email Address Change Change email address for credentialing contact, provider directory update notices and other notifications from Network Administration. Gender Change Change gender. Languages Spoken Change Change languages spoken. Maternity, Military Or Sabbatical Leave Of Absence

Notify Wellmark of military assignment, sabbatical or maternity leave.

Name Change Change the name of a group, clinic, facility, entity or a practitioner. NPI Change Change national provider identifier (NPI) for one or more providers.

Payment Authorization Change Change authorization of payment to be made to the clinic on behalf of a group of two or more practitioners. Phone or Fax Change Change main office or scheduling phone, fax, or TDD number.

Specialty Change Change one or more practitioner specialty roles or area of focus at a practice location. TIN Change Update a tax identification number (TIN) for one or more providers at

one or more practice locations and simultaneously update associated billing address(es), organizational national provider identifier (NPI) and group/clinic name.


How to Submit a Change Request

Accepting New Patients or Age Limitations Change 1. Select a TIN. TIN 2. Select one practitioner’s NPI who is changing his/her acceptance of new patients

or age limitations. Note: You will be able to select additional practitioners later. PROVIDER

3. Select the practice address for the provider whom you wish to change the accepting new patients/age limitations for.

ADDRESS 4. Select the NPI(s) of the other practitioners at the address you selected who are

changing accepting new patients/age limitations. OTHER PROVIDER(S)

5. Review the current accepting new patients/age limitations detail for each practitioner selected. Once you have reviewed and made your updates, please check the box at the bottom of the page to continue.

ACCEPTING NEW PATIENTS/AGE LIMITATIONS DETAIL

6. Enter in the effective date for the change.

EFFECTIVE DATE

7. Review and confirm your selections. CONFIRM 8. Review and attest to the information you submitted by checking the box and

providing your electronic signature. The date cannot be modified and is defaulted to the date of submission. At the bottom of the page there will be a checkbox for an email confirming your submission. This is defaulted as checked and will go to the email address associated with the account.

ATTESTATION


Address Update: Cancel practice location address 1. Select the type of Address Cancel you would like to complete.

TYPE OF ADDRESS CANCEL

2. Select a TIN. TIN 3. Select one provider’s NPI for which you would like to cancel an address. Note:

You will be able to add other providers to cancel later. PROVIDER

4. The addresses the provider is associated with will display. Select the address(es) you would like to cancel.

ADDRESS(ES) 5. Select the NPI(s) of the other providers for which you’d like to cancel an address.

If no other providers, click Continue. OTHER PROVIDER(S)

6. Select the reason for the cancellation in the drop down box: - Retired - Deceased - Moved out of state - No longer at address

REASON AND DATE

Select the effective date of the address cancellation for each provider using the date picker. If the reason and/or date apply to all providers, enter the information in for the first provider and check the box(es).

IMPORTANT If you indicate you are cancelling an address due to death, all other

addresses and practitioner information will be cancelled.


providing your electronic signature. The date cannot be modified and is defaulted to the date of submission. At the bottom of the page there will be a checkbox for

ATTESTATION


an email confirming your submission. This is defaulted as checked and will go to the email address associated with the account.

Address Update: Change practice location address 1. Select a TIN. TIN 2. Select the provider’s NPI who is moving. Note: You will have the ability to add

additional providers later. PROVIDER

3. Select the address for the provider you would like to change. You will have the ability to change the billing address in later steps.

CURRENT ADDRESS 4. Answer the questions about the type of address change. TYPE OF ADDRESS

CHANGE 5. Enter in the complete full address the provider is moving to. Note: The address

you enter will be converted to U.S. Postal standards.

IMPORTANT Do not type the provider information in all CAPS. If the data is entered is

in all CAPS, this is the way the data will appear in Wellmark’s systems and viewable back to you within E-cred Central.

NEW ADDRESS

6. Answer the additional practice location questions (see next page). PRACTICE LOCATION QUESTIONS


If you select “no” for any of the practice location questions, you will be required to supply a reason.

7. Select the NPI(s) of the other providers who are moving practice locations. If no

other providers are included in this change, continue to the next step. OTHER PROVIDER(S)

8. Enter in the practitioner(s) details for each provider(s) including the scheduling phone number, credentialing contact email address and notification email address.

PROVIDER DETAIL

9. Review the practitioner(s) details and modify if necessary. If the practitioner has age limitations, two fields will appear to allow you to enter in the ‘from’ and ‘to’ ages.


Once you have completed your review/updates, please check the box at the bottom of the page to continue.

10. If the billing address in addition to the practice address is changing, enter in the new billing address. You may add others by repeating this step. If you would like to use the new practice address as the new billing address, click the checkbox.



NEW BILLING ADDRESS

11. Select the NPI of the practitioners who will be using the billing address. SELECT PRACTITIONERS

12. Select the effective date for the address change. EFFECTIVE DATE 13. Review and confirm your selections. CONFIRM 14. Review and attest to the information you submitted by checking the box and


ATTESTATION


Admitting Privileges Change Admitting privileges are required for DMDs, MDs, and DOs, and all specialties excluding Allergy, Anesthesiology, Dermatology, Emergency Medicine, Genetics, Occupational Medicine, Pathology, Psychiatry, and Radiology. Admitting privileges are required for PAs, ARNPs and CNMs acting in a PCP or PCP-OB/GYN role. 1. Select a TIN. TIN 2. Select the practitioner’s NPI whose admitting privileges you would like to change. PROVIDER 3. Update the practitioner’s admitting privileges. You will have the option to either

add a new admitting privilege location or add a participating physician or physician group to admit your patients on your behalf. If you would like to add a participating physician or physician group to admit patients on the practitioner’s behalf, enter in the new referring physician or physician group.

UPDATE ADMITTING PRIVILEGES

4. Change the practitioner’s admitting privileges as you wish. You have the option of removing the practitioner’s current admitting privileges, adding a new admitting privilege location, or adding a participating physician or physician group to admit your patients on your behalf.

ADD OR REMOVE ADMITTING PRIVILEGES



ATTESTATION


Backup Provider Change DMDs, MDs, DOs, PAs and ARNPs practicing as PCPs or OB/GYNs participating in Wellmark HMO Networks are required to have a backup provider. If this does not apply to you, the Backup Provider Change is not required. 1. Select a TIN. TIN 2. Select one practitioner’s NPI who is changing their backup provider. Note: You

will be able to select additional practitioners later. PROVIDER

3. Select the practice address for the practitioner whose backup provider you would like to change.

ADDRESS 4. Select the NPI(s) of the other practitioners who are changing their backup. If no

other practitioners, click Continue. OTHER PROVIDER(S)

5. Add the backup provider(s) at the address for the practitioner(s) listed. You may add others by repeating this step.



ADD BACKUP PROVIDER



ATTESTATION


Board Certification or Accreditation Change 1. Select a TIN. TIN 2. Select the NPI(s) of the provider(s) whose board certification or accreditation is

changing. PROVIDER

3. Change the boards or certifications for the selected provider(s). To enter additional boards or certifications, complete the fields in the screenshot below. After clicking the Add button, you may add others by repeating this step. You will also have the ability to remove any current accreditations.

CHANGE BOARDS OR CERTIFICATIONS



ATTESTATION


Email Address Change Select the type of email change you would like to complete.

Provider Directory Update Email Address

Change email address for provider directory update notices for one or more providers. 1. Select a TIN. TIN 2. Select the NPI(s) of the provider(s) whose directory validation email address you

would like to change. PROVIDER

3. Change the providers’ directory validation email address. CHANGE EMAIL 4. Review and confirm your selections. CONFIRM 5. Review and attest to the information you submitted by checking the box and

providing your electronic signature. The default date is the date of submission. At the bottom of the page will be a checkbox for an email confirming your submission. This is defaulted as checked and will go to the email address associated with the account. If you do not wish to receive an email confirmation, uncheck the box.

ATTESTATION

Notification or Credentialing Contact Email Change email address for credentialing contact and other notifications from Network Administration for one or more

providers at a practice location. 1. Select a TIN. TIN 2. Select one provider’s NPI who is changing their notification email or credentialing

contact email information. Note: You will be able to select additional providers later.

PROVIDER

3. Select the practice address for the provider whose notification or credentialing contact email you would like to change.

ADDRESS 4. Select the NPI(s) of the other practitioners who are changing their notification or

credentialing contact email. If no other providers are included in this change, click Continue.

OTHER PROVIDER(S)

5. Change the notification email and/or credentialing contact information for the providers you selected.

CHANGE EMAIL 6. Review and confirm your selections. CONFIRM 7. Review and attest to the information you submitted by checking the box and


ATTESTATION


Gender Change 1. Select a TIN. TIN 2. Select the practitioner’s NPI. PROVIDER 3. Select correct gender. PROVIDER CHANGES 4. Enter a date for this change. EFFECTIVE DATE 5. Review and confirm your selections. CONFIRM 6. Review and attest to the information you submitted by checking the box and


ATTESTATION


Languages Spoken Change 1. Select a TIN. TIN 2. Select a practitioner’s NPI. PROVIDER 3. You can either remove the current languages spoken or add language(s).

IMPORTANT If the practitioner knows sign language and you want to indicate this in

the practitioner’s information, click on the Knows sign language checkbox.

LANGUAGES SPOKEN



ATTESTATION


Maternity, Military or Sabbatical Leave of Absence 1. Select a TIN. TIN 2. Select a provider’s NPI. PROVIDER 3. Select the reason for leave of absence and the dates for the leave of absence.

Note: If you are unsure of the return date, estimate the date the provider will be returning. If your return date needs to be corrected, submit a new leave of absence request.

REASON AND EFFECTIVE DATES



ATTESTATION


Name Change Select the type of name change you would like to complete.

Group, Clinic, Facility, or Entity Name Change

IMPORTANT If the intended Group, Clinic and/or Facility/Entity name change is a result of a TIN change, return to

the Change Request Tool lobby and select TIN change to submit your request. If your intended Group, Clinic and/or Facility/Entity name change is not related to a TIN change, please continue to submit your request.

Group/Clinic Legal Name only (name associated

with TIN) “Doing Business As” name Both

*A pop-up message will appear letting you know this change will affect all locations and practitioners under your TIN. In addition, a message will appear letting you know you will have the chance to upload a completed W9 form in later steps. 1. Select a TIN. 2. Change group/clinic legal

name. This must be an exact match as the legal name on the W9.

3. Enter a date for the change.

1. Select a TIN. 2. Select the address(es) whose

Doing Business As (DBA) name you would like to change.

3. Change DBA name(s). 4. Enter a date for the change.

*A pop-up message will appear letting you know this change will affect all locations and practitioners under your TIN. In addition, a message will appear letting you know you will have the chance to upload a completed W9 form in later steps. 1. Select a TIN. 2. Change the group/clinic legal


3. Select the address(es) whose DBA name you would like to change.

4. Update DBA name(s). 5. Enter a date for the change.

- Upload a completed W9 in an electronic format (PDF, gif, jpg, etc.). - Review and confirm your selections. - Review and attest to the information you submitted by checking the box and providing your electronic

signature. The default date is the date of submission. - At the bottom of the page will be a checkbox for an email confirming your submission. This is defaulted as

checked and will go to the email address associated with the account. If you do not wish to receive an email confirmation, uncheck the box.


Group, Clinic, Facility, or Entity Name Change Facility/Entity

*A message will appear letting you know you will have the chance to upload a completed W9 form in later steps. 1. Select a TIN. 2. Select the NPI(s) of the provider(s) whose name you would like to change. 3. Update facility/entity name(s). 4. Enter a date for the change. 5. Upload a completed W9 in an electronic format (PDF, gif, jpg, etc.). 6. Review and confirm your selections. 7. Review and attest to the information you submitted by checking the box and providing your electronic

signature. The default date is the date of submission. At the bottom of the page will be a checkbox for an email confirming your submission. This is defaulted as checked and will go to the email address associated with the account. If you do not wish to receive an email confirmation, uncheck the box.

Group, Clinic, Facility, or Entity Name Change Both

*A message will appear letting you know you will have the chance to upload a completed W9 form in later steps. 1. Select a TIN. 2. Select the NPI(s) of the provider(s) whose name you would like to change. 3. Update the facility/entity name(s). 4. Select the type of group/clinic name you would like to change. Legal Name only (name associated

with TIN) “Doing Business As” name Both

*A pop-up message will appear letting you know this change will affect all locations and practitioners under your TIN. 5. Change the group/clinic legal


6. Enter a date for the change.



*A pop-up message will appear letting you know this change will affect all locations and practitioners under your TIN. 4. Change group/clinic legal




- Upload a completed W9 in an electronic format (PDF, gif, jpg, etc.). - Review and confirm your selections. - Review and attest to the information you submitted by checking the box and providing your electronic

signature. The default date is the date of submission. - At the bottom of the page will be a checkbox for an email confirming your submission. This is defaulted as

checked and will go to the email address associated with the account. If you do not wish to receive an email confirmation, uncheck the box.


Practitioner Name Change *Note: A marriage certificate or any other documentation is not needed to submit a name change. 1. Select a TIN. 2. Select a practitioner’s NPI. 3. Update the practitioner’s name. 4. Enter a date for the change. 5. Review and confirm your selections. 6. Review and attest to the information you submitted by checking the box and providing your electronic

signature. The default date is the date of submission. At the bottom of the page will be a checkbox for an email confirming your submission. This is defaulted as checked and will go to the email address associated with the account. If you do not wish to receive an email confirmation, uncheck the box.


NPI Change 1. Select the type of NPI you would like to change:

- A rendering NPI for one or more individual providers - An organizational NPI for a group or clinic - An organizational NPI for a facility or entity

Note: An additional question will appear for an organizational NPI change for a facility or entity asking if your TIN is also changing. If yes, you will receive a pop-up message indicating you will need to complete a new application for that and you will be redirected to the application to complete.

TYPE OF NPI CHANGE

2. Select a TIN. TIN 3. Select the NPI(s) of the provider(s) whose NPI you would like to change. PROVIDER 4. Select addresses for each practitioner that will be changing the organizational

NPI. PRACTICE ADDRESSES

5. Change the NPI for each provider.

NPI CHANGE DETAIL

6. Enter a date for the change. EFFECTIVE DATE 7. Review and confirm your selections. CONFIRM 8. Review and attest to the information you submitted by checking the box and


ATTESTATION


Payment Authorization Change 1. Select a TIN. TIN 2. Select one practitioner’s NPI whose payment authorization you would like to

change. Note: You will be able to select additional practitioners later. PROVIDER

3. Select the practice address at which you would like to change Payment Authorization for the practitioner.

ADDRESS 4. Select the NPI(s) of the other provider(s) whose Payment Authorization is

changing. If no other providers are included in this change, click Continue. OTHER PROVIDER(S)

5. Change the provider payment authorization by entering in the following information displayed in the screenshot below.

PROVIDER PAYMENT AUTHORIZATION

6. Enter the effective date for the change. EFFECTIVE DATE 7. Review and confirm your selections. CONFIRM 8. Review and attest to the information you submitted by checking the box and


ATTESTATION


Phone or Fax Change Select the type of phone or fax change you would like to complete.

Scheduling Phone or Fax Number Change (for NPI)

Change scheduling phone or fax number for one or more providers at a practice location. *A pop-up will appear indicating the scheduling phone number will appear in the provider directory. 1. Select a TIN. TIN 2. Select a provider’s NPI whose scheduling phone or fax number you would like to

change. Note: You will be able to select additional providers later. PROVIDER

3. Select the practice address at which the scheduling phone or fax number you would like to change.

CURRENT ADDRESS 4. Select other provider(s) at the address you selected for whom you wish to change

the scheduling phone or fax number. If no other providers are included in this change, click Continue.

OTHER PROVIDER(S)

5. Change the providers’ scheduling phone or fax number. The provider’s current scheduling phone and fax number will display.

SCHEDULING PHONE/FAX NUMBER

6. Enter a date for the change. EFFECTIVE DATE 7. Review and confirm your selections. CONFIRM 8. Review and attest to the information you submitted by checking the box and


ATTESTATION

Main Office Phone Number Change Change main office phone, fax or TDD number at a practice location.

A pop-up will appear indicating to change the phone number that appears in the provider directory you will need to complete the scheduling phone number change. 1. Select a TIN. TIN 2. Select an address affected by the changes. ADDRESS 3. Change the main office phone, fax, and/or TDD number(s). The provider’s current

main office phone number, fax number, and TDD phone number will display. NEW MAIN OFFICE – PHONE, FAX, TDD NUMBER(S)


4. Enter the effective date for this change. EFFECTIVE DATE 5. Review and confirm your selections. CONFIRM 6. Review and attest to the information you submitted by checking the box and


ATTESTATION


Specialty Change 1. Select a TIN. TIN 2. Select one practitioner’s NPI whose specialty you would like to change. PROVIDER 3. Select one address at which you’d like to change a specialty for the practitioner. If

you need to update the practitioner’s specialty at multiple practice locations or if you have multiple TINs that a practitioner is listed under, you will need to submit a specialty change for each practice location.

ADDRESS

4. Choose the type of change: - Add another specialty/specialty service - Change your current specialty - Remove one of your specialties

On this step you can also reorder the primary and secondary specialties for a provider. To do this, select Remove one of your specialties, then select Primary Specialty. You will be prompted to answer a question about what you would like to use as the new primary specialty. From there you can select Change a Secondary Specialty to Primary and then select the secondary specialty from the list of secondary specialties associated with the practitioner you selected.

WHAT DOES PRACTICE FOCUS MEAN? Physician assistants and nurse practitioners have the ability to change

their practice focus meaning a sub-specialty in which you practice (i.e., family practice, orthopedic surgery, psychiatry, etc.).

ADDRESS

5. Select the specialty you are adding, changing, or removing. If you are changing your current specialty, you will be advised to indicate which of your current specialties you would like to change.

ADD SPECIALTY

6. Provide details for the practitioner for the new specialty.

DETAILS

7. Enter a date for which the change takes effect. EFFECTIVE DATE 8. Review and confirm your selections. CONFIRM 9. Review and attest to the information you submitted by checking the box and


ATTESTATION


TIN Change Select what type of TIN you would like to change. - A TIN for one or more individual practitioners - A TIN for a facility or entity If you are changing a TIN for one or more individual practitioners and the practice address is not changing, additional questions will appear.

NOTE If you would like to change the TIN for a facility or

entity you will need to complete a new application. Once you select the radio icon and continue, a pop-up message will display and you will be redirected to the application to complete.

*A message will appear indicating you will be asked to upload a completed W9 form. 1. Select a TIN. TIN 2. Select the practice address(es) affected by the TIN change. ADDRESS 3. Based on the address(es) you have chosen, select the NPI(s) of the practitioner(s)

whose TIN is changing. PROVIDER(S)

4. Enter new TIN and answer the question below the fields.

If you are billing as a clinic and you want the payment to come to you in the name of the clinic, you will need to enter in the clinic name and payment address.

NEW TIN

5. Upload W9 that is associated to the TIN. UPLOAD W9 6. Enter a date for the change. EFFECTIVE DATE 7. Review and confirm your selections. CONFIRM 8. Review and attest to the information you submitted by checking the box and


ATTESTATION


Overview The Recredentialing Tool allows users to complete and submit recredentialing applications online for providers who recredentialing is due.

Navigation On the Recredentialing Tool lobby you have the ability to see all providers either due for recredentialing or the providers that have been recredentialed in the past 30 days. The tool will default to the “Providers Due For Recredentialing” with the most urgent notification status being first.

On the “Providers Due For Recredentialing” tab, users have the ability to search by NPI or Provider Name.

Recredentialing Tool


Users can sort results by clicking on the column headers or clicking on the icon of the status you want to display at the top of the list. See the Icons section for descriptions of the icons.

On the “Providers Recredentialed in the Past 30 Days” tab all completed recredentialing applications will display. The completed recredentialing applications will remain on the list for 30 days.


Icons

Icon What it means First Notification Sent Recredentialing deadline is 90 days after first notification.

Second Notification Sent Recredentialing deadline is 60 days after second notification.

Final Notification Sent Provider will be terminated 60 days after final notification is sent.

Received The recredentialing application is in progress. Details can be found by clicking Check Status.

Recredentialing Complete Recredentialing is completed for this provider. Recredentialed providers remain on the list for 30 days.

The following icons appear on the Confirmation page:

Acknowledged Information within the provider’s recredentialing application was acknowledged.

Added Information within the provider’s recredentialing application was added.

Removed Information within the provider’s recredentialing application was removed.

Updated Information within the provider’s recredentialing application was updated.

Warning A negative change in the provider’s information was made. The provider’s recredentialing application may be reviewed by the Credentialing Committee.

Notifications Recredentialing notifications are sent to all credentialing contact email address(es) Wellmark has on file for the provider prior to the provider’s recredentialing deadline. The first notification is sent four (4) months from the recredentialing deadline. The second notification is sent three (3) months before the recredentialing deadline. The final notification is sent two (2) 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.

On the Recredentialing Tool lobby there are icons that indicate the provider’s status in the recredentialing process. By clicking on the orange ( ) next to “What do the icons mean?” descriptions of each icon will display as indicated on the next page.

First Notification

Sent 4 months before recredentialing due

date

Second Notification

Sent 3 months before recredentialing due

date

Final Notification

Sent 60 days before recredentialing due

date

Recredentialing Due Date


How to Recredential a Provider The following steps should be completed to recredential any practitioner, facility, or entity that is due for recredentialing. Providers will only need to complete the screens applicable to the provider’s recredentialing application. If a provider is credentialed with multiple TINs, only one recredentialing application is required per provider and should apply across all TINs. In the event you log out of E-cred Central before you have completed the recredentialing application, the application will not be saved and you will have to complete the application again.

Recredentialing Steps 1. Click on the Recredential button for the provider you are recredentialing. At the end of the recredentialing

application you will have the opportunity to upload documentation to support any of your selections or responses.

2. The provider’s current board certifications or other certifications will display. On

this step you will have the opportunity to update the expiration date, add another board certification or other certification, or move on to the next step.

IMPORTANT Not all providers are required to have boards, admitting privileges, etc. You

will only see the screens that are applicable to the provider’s recredentialing application that you are completing.

BOARD CERTIFICATIONS OR OTHER CERTIFICATIONS

IMPORTANT For any negative change submitted throughout the Recredentialing Tool, a pop-up will display indicating

the Credentialing Committee will review. You may also receive an error message and you will not be able to proceed until you have added information. See Chapter 3 of the “Credentialing and Network Participation” section of the Wellmark Provider Guide for the credentialing and contracting requirements.

http://www.wellmark.com/Provider/CommunicationAndResources/PDFs/S5780_ContractsandCredentialingProviderGuide.pdfhttp://www.wellmark.com/Provider/CommunicationAndResources/PDFs/S5780_ContractsandCredentialingProviderGuide.pdf


3. The provider’s current state licenses will display. On this step you will have the opportunity to update the expiration date, add another license, or move on to the next step.

To enter additional licenses, complete the fields shown in the screenshot below. You may add other licenses by repeating the process.

If you do not update the expiration date, you will be prompted and required to explain why the license is expiring.

LICENSES

4. The provider’s current registrations, certifications, or endorsements will display. On this step you will have the opportunity to add another certification, update the expiration date, or continue to the next step.

To enter additional registrations, please complete the fields shown in the screenshot below. You may add others by repeating the process.

If you do not update the expiration date, you will be prompted and required to explain why the license is expiring.

If you select “no” and continue to the next step, an additional step will appear. If there is another practitioner who has been identified as someone whom can prescribe on the practitioner’s behalf, the practitioner’s name will display. If not, you will have the chance to add a new referring physician or physician group, who can prescribe on your behalf.

REGISTRATIONS


5. The provider’s current admitting privileges will display. On this step you will have

the opportunity to modify the admitting privileges or continue to the next step. Please be sure to only modify the admitting privileges you have knowledge about. If you modify your Admitting Privileges you can either:

- Remove the current admitting privileges. - Add a new admitting privilege location. - Enter a different location not found on the list provided.

If you remove the provider’s admitting privileges, you will be prompted to identify the provider’s current referral mechanism either by adding an admitting privilege location or adding or removing a participating physician or physician group to admit patients on the provider’s behalf. To add a new referring physician or physician group, enter information into the fields shown in the screenshot below.

ADMITTING PRIVILEGES

6. The provider’s current malpractice insurance coverage will display. On this step you will have the opportunity to update the effective date and expiration date for expired malpractice coverage, enter a different malpractice policy, or continue to the next step.

To add another malpractice policy, please complete the fields shown in the screenshot on the next page.

MALPRACTICE INSURANCE COVERAGE


WHAT’S THIS?

Hovering over the orange question mark will provide a description for each malpractice coverage type.

7. Answer the quality focus questions. If you answer “yes” to any of the questions you will be prompted to provide an explanation. For each “yes” response, an explanation is required. If your explanation exceeds space provided, or if you would like to provide additional documentation to support your explanation, you will have an opportunity to attach document(s) before completing the application.

QUALITY FOCUS QUESTIONS

8. Enter in a directory validation email. This email will be used to verify the practitioner information in Wellmark’s directory for all practice locations. Once you are finished reviewing and modifying the email address, click the checkbox to continue.

DIRECTORY VALIDATION EMAIL

9. Enter the credentialing contact information. This information will be used as contact for provider credentialing and recredentialing application.

Enter a notification email address. This will be used to send electronic confirmation communications. If it is the same email address as the credentialing contact, simply click the checkbox.

CREDENTIALING CONTACT INFORMATION AND NOTIFICATION EMAIL ADDRESS


10. Upload additional

Documents

E-CREDENTIALING CENTRAL USER GUIDE · 2018. 5. 11. · This User Guide provides an overv iew of E-credentialing (E-cred) Central, explains how to use the E-cred Central tools to submit