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Get Wellmark Confirmation Of Msp Addendum
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How to fill out the Wellmark Confirmation of MSP Addendum online
The Wellmark Confirmation of MSP Addendum is an essential document for healthcare providers seeking to participate in Wellmark networks. This guide provides clear, step-by-step instructions on how to effectively fill out the form online, ensuring that all necessary information is accurately provided.
Follow the steps to accurately complete the form online.
- Click 'Get Form' button to obtain the document and open it in the editing interface. This allows you to access the online fillable form.
- Begin by providing your professional credentials, including whether you are an M.D., D.O., or other specified practitioner types. Indicate your hospital admitting privileges, if applicable.
- In the Obstetrical Services section, respond to the questions regarding obstetrical services you provide. Select 'Yes' or 'No' as appropriate.
- For prescribing capabilities, indicate the state or federal controlled substance levels that you can prescribe, and list any necessary details as required.
- Fill out the Licensing Information for psychologists, if applicable, including your registration number and issue dates.
- Complete the Site Specific Information section for your practice address, including necessary contact and credentialing details.
- Answer health status questions honestly to ensure compliance with Wellmark standards. If necessary, provide explanations for any 'Yes' answers.
- In the Malpractice section, include your policy details, including the insurance carrier and coverage amounts.
- Fill in Directory Information to indicate if you wish to be listed in the provider directory.
- Complete the Back-Up Physician Information section by entering additional providers who will cover for you.
- Finally, review all entries for accuracy, sign and date the certification and release statement, and ensure all supplementary documents are attached as required.
- Once you have completed the form, save your changes, and choose to download, print, or share the completed form as necessary.
Complete your forms online today and ensure your participation in Wellmark networks.
The phone number for Wellmark's prior authorization varies based on the specific service needed. Generally, you can find this information on the Wellmark website or your insurance card. When contacting them, mention the Wellmark Confirmation Of Msp Addendum to expedite the process and ensure you provide all necessary details.
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