Wellmark and BCBS may seem like interchangeable terms, but they're not exactly the same thing. Wellmark is actually the insurance company behind Blue Cross Blue Shield (BCBS) in Iowa and South Dakota.
The key difference lies in the fact that BCBS is a national network of insurance companies, while Wellmark is a specific company that operates within that network. This distinction affects how you access care and what your out-of-pocket costs are.
Wellmark's membership in the BCBS network means that you can use your BCBS insurance to see doctors and hospitals across the country, not just in Iowa and South Dakota. This freedom to roam can be a big plus for people who travel or have family members in other parts of the country.
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What is BlueCard?
The BlueCard Program is an electronic network that connects providers across the country and around the world for claims processing and payment.
It's designed to make it easy for providers like you to work with members of other Blue Cross and Blue Shield (BCBS) Plans.
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The BlueCard Program typically applies when a provider contracted with Wellmark is servicing a member of another BCBS Plan.
This means you can use the BlueCard program as your one-stop-shop for claims submissions, inquiries, status updates, and payment for BlueCard members.
BlueCard also provides easy access to member eligibility, benefits, and authorizations.
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Using BlueCard
Using BlueCard, you can access benefits and eligibility information for out-of-state BCBS Plan members. If you're a Wellmark participating provider, you can check eligibility and benefits through the Out-of-area Membership Search tool on the Secure Site.
To do this, you'll need to include the first three alpha characters on the member's ID card. You can also call 800-676-BLUE (2583) for assistance.
Here's a step-by-step guide to submitting BlueCard claims:
- Member with an out-of-state BCBS Plan receives services from a Wellmark provider.
- The Wellmark provider submits the claim to Wellmark.
- Wellmark recognizes the BlueCard member and transmits the claim to the member’s BCBS Plan.
- The member’s BCBS Plan adjudicates the claim according to member’s benefit Plan.
- The member’s BCBS Plan issues an Explanation of Benefits (EOB) to the member.
- The member’s BCBS Plan transmits claim payment information to the local provider’s BCBS Plan.
- Wellmark reimburses participating providers and issues the Provider Claims Remittance (PCR).
Wellmark and BlueCard
Wellmark and BlueCard are closely connected. The BlueCard Program connects providers of all Blue Cross and Blue Shield (BCBS) Plans across the country and around the world through an electronic network of claims processing and payment.
As a Wellmark participating provider, you can check eligibility and benefit information using the Out-of-area Membership Search tool on the Secure Site. This is a one-stop-shop for claims submissions, inquiries, status updates, and payment for BlueCard members.
If you're an out-of-state provider participating with another BCBS Plan, you can access eligibility and benefits information through your local BCBS Plan's website. Simply include the first three alpha characters on the Wellmark member's ID card in your search.
You can also call 800-676-BLUE (2583) for assistance with checking eligibility and benefits.
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Frequently Asked Questions
What states does Wellmark cover?
Wellmark Blue Cross and Blue Shield serves members in Iowa and South Dakota. Our coverage spans these two states, offering a wide range of health insurance options.
Is Blue Cross Blue Shield available in Iowa?
Yes, Blue Cross Blue Shield is available in Iowa through Wellmark Blue Cross and Blue Shield, offering health insurance plans to eligible employees.
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