Wellmark Blue Cross and Blue Shield
South Dakota/Iowa • Medicare Advantage, EPO, Traditional Indemnity
Medicare Advantage (MA) coverage means this member receives their Medicare benefits through a private BCBS plan rather than through original Medicare. MA plans may have different payer IDs and claims addresses than the commercial plan. Check with the payer to confirm the correct submission details for Medicare Advantage claims.
Under this EPO prefix, the member has no out-of-network coverage for routine care. However, unlike HMO plans, no referral is needed to see a specialist within the network. When billing, confirm the provider's network participation status with the plan before submitting the claim.
This is a traditional indemnity prefix. Unlike managed care plans (HMO, PPO, EPO), indemnity plans do not use provider networks. There are no referral requirements and no restrictions on which providers the member can see. Submit claims to the payer listed above for reimbursement at the plan's allowed rate.
Health insurance company serving Iowa and South Dakota with commercial and other plans.