Get the up-to-date wellmark request for reimbursement form 2024 now

Get Form
wellmark request for reimbursement form Preview on Page 1

Here's how it works

01. Edit your form online
01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

How to change Wellmark request for reimbursement form online

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2

With DocHub, making changes to your paperwork takes only a few simple clicks. Follow these quick steps to change the PDF Wellmark request for reimbursement form online for free:

  1. Sign up and log in to your account. Sign in to the editor with your credentials or click Create free account to examine the tool’s features.
  2. Add the Wellmark request for reimbursement form for editing. Click the New Document button above, then drag and drop the sample to the upload area, import it from the cloud, or using a link.
  3. Adjust your template. Make any changes required: insert text and pictures to your Wellmark request for reimbursement form, underline important details, remove sections of content and substitute them with new ones, and add symbols, checkmarks, and areas for filling out.
  4. Complete redacting the form. Save the modified document on your device, export it to the cloud, print it right from the editor, or share it with all the parties involved.

Our editor is super intuitive and efficient. Try it now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
To receive benefits for drugs, or for services by a provider who does not bill us directly, complete the claim form, attach itemized bills, and mail to: Wellmark Blue Cross and Blue Shield of Iowa, Mail Station 1E238, PO Box 9291, Des Moines, Iowa 50306-9291. Please do not use highlighter pens.
You would need to fill out the name of the insured, their relationship with the primary insured person under the policy, their contact details, and their occupation. Now, youd need to fill out details regarding the hospitalization of the insured patient.
The 180 day timely filing guideline will also apply to COB claims. When Wellmark is the secondary payer, claims must be filed within 180 days from the issue date of the primary payers Explanation of Benefits (EOB).
GS03 Use the payer ID 88848.
To receive benefits for drugs, or for services by a provider who does not bill us directly, complete the claim form, attach itemized bills, and mail to: Wellmark Blue Cross and Blue Shield of Iowa, Mail Station 1E238, PO Box 9291, Des Moines, Iowa 50306-9291.

People also ask

How to Find Timely Filing Limits With Insurance Insurance CompanyTimely Filing Limit (From the date of service)Wellmark BCBS Iowa and South Dakota180 DaysBCBS Alabama2 YearsBCBS Arkansas180 DaysBCBS Idaho180 Days28 more rows
GS03 Use the payer ID 88848.
Initial disputes must be submitted within 365 days, or the time specified in the providers contract, whichever is greater, of Blue Shields date of contest, denial, notice, or payment.

Related links