BCBS AFFILIATESD, IAPBM: Express Scripts
Wellmark BCBS (South Dakota) Prior Authorization Guide
Submit prior authorization requests and appeal denials with Wellmark BCBS SD. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for SD, IA providers.
Prior Authorization Contacts
PA PHONE
1-800-524-9178
PA FAX
1-515-376-4752
TURNAROUND
15 days standard, 72h expedited
TIMELY FILING
180 days
APPEALS MAILING ADDRESS
Wellmark BCBS, Attn: Appeals Department, PO Box 9232, Des Moines, IA 50306
Common Denial Reasons
- ⚠ Wellmark Medical Policy criteria not met
- ⚠ Step therapy required
- ⚠ Non-preferred formulary
- ⚠ Site of care
Step Therapy Requirements & Override Rights
Wellmark serves both Iowa and South Dakota. South Dakota has no state-level step therapy override law, but Iowa's laws apply to multi-state operations. Wellmark Medical Policy typically requires 3-month DMARD trial for biologics.
Tips for Wellmark BCBS SD Submissions
- 1. Wellmark covers both SD and IA â same Medical Policy applies
- 2. Submit via Availity
- 3. Reference Wellmark Medical Policy number
- 4. Express Scripts handles pharmacy
External Review Authority
If Wellmark BCBS SD denies your final internal appeal, you have the right to request an external review through: South Dakota Division of Insurance / Iowa Insurance Division.
External review decisions are binding on the insurer.