Purpose of this manual this provider manual is intended for wellcare contracted participating medicaid providers providing health care services to wellcare members enrolled in a wellcare medicaid managed care plan. The secure portal enables providers to check member eligibility, submit authorizations and claims, complete training, and more. We are excited to share that meridiancare, a wellcare company, is changing its name to wellcare, effective january 1, 2020. Complete a brief profile and accept hipaa terms and conditions. The enclosed provider manual is your guide to working with us. You will need it when registering for our secure provider portal and for managing your business with wellcare health plans, inc. There are a number of medicare plans in massachusetts. Sunshine health and wellcare of florida provider manuals will continue to apply to the operation of each plans existing contracts. This manual serves as a guide to the policies and procedures governing the administration of. An eye surgeon who performs lens implant surgery for cataracts and who takes medicare can provide a list of local eyeglass providers who take medicare, acc an eye surgeon who performs lens implant surgery for cataracts and who takes medicar.
Non wellcare providers provider bulletins provider newsletters medicaid authorizations medicare authorizations claims payment policies medicaid claims payment policies medicare. Maximize your wellcare experience wellcare understands that having access to the right tools and resources are important to help you and your staff streamline daytoday administrative tasks. All providers, including provider employees and subcontractors, their employees and delegated entities are required to comply with wellcare s compliance program requirements. Behavioral health services are managed by the wellcare behavioral health integrated program. If you need assistance making a connection with change healthcare or have any questions, please contact change healthcare directly at 18774117271, or your vendor may call 180052783. Medicare is a governmentfunded health insurance program for people 65 and older or who have certain disabilities.
March 27, 2019 version 4 page 2 of 118 wellcare of nebraska provider manual verified 4 days ago url. This approach to care enables one integrated care management team responsible for both medical and behavioral health. Contains key phone numbers and information on claims, appeals and more. This guide can help you understand medicare and medicare advantage plans in west virginia, eligibility for medicare plans, enrollment resources, and helpful tips for enrollment. Our selfservice channels are the best way to fight the coronavirus covid19. Wellcare of michigan partners with providers to develop and deliver highquality, costeffective health care solutions. Medicare part a pays for most of the cost of hospitalization and other inpatient stays for. Wellcare will evaluate the request based on applicable medical criteria, fda. Purpose of this manual this medicare advantage provider manual is intended for wellcarecontracted participating medicare providers providing health care services to wellcare medicare advantage members enrolled in a wellcare medicare advantage plan. At wellcare health plans, we value everything you do to deliver quality care to our members your patients and to make sure they have a positive healthcare experience. This manual serves as a guide to the policies and procedures governing the administration of wellcare s medicare advantage plans and is an extension of and supplements the. The following resources are available to assist providers. Quality highlights section 2 responsibilities of all providers access standards cultural competency program and plan member rights and responsibilities section 3.
Wellcare s integrated care model strongly encourages communication between behavioral health providers and pcps. These payer only codes above are assigned by the medicare. Wellcare health plans provides managed care services for medicare and is a whollyowned subsidiary of centene corporation, a leading multiline healthcare enterprise. Le, and the more than 69,000 providers nationwide who already partner with wellcare, please send us your information by completing our online form. Wellcare partners with providers to develop and deliver highquality, costeffective health care solutions. The letter identifies medicare eligible beneficiaries, claim control. What cancer patients, their families, and caregivers need to know about the coronavirus. Medicare provider manual get detailed health plan information on important topics such as coverage procedures and policies.
Details the various tools available to help providers do business with wellcare. This provider manual is an extension of your easy choice health plan agreement and provides additional information and guidance to assist you with the. To maintain continuity of care, patient safety and member wellbeing, this exchange is critical, especially for members with comorbidities receiving pharmacological therapy. Mi meridian wellcare health plan office reference manual. Learn more about how were supporting members and providers. A federal government website managed and paid for by the u. How do i submit claims for reimbursement for a dsnp member if wellcare and the state have a contract. Effective 1112019, we will introduce new coding integrity reimbursement guidelines based on industry standards, coding rules published within the medicare claims processing manual. Wellcare partners with providers to give members highquality, lowcost health care and we know that having a healthy community starts with those who need it most. All participating providers are responsible for adhering to the participation agreement and the provider manual. Wellcare partners with providers to give members highquality, lowcost health care. Ky medicaid provider training orientation printable.
People who can receive medicare are those who are 65 years and older, those who have certain illnesses and disabilities, or those who need dialysis or a ki people who can receive medicare are those who are 65 years and older, those who have. Wellcare health plans medicare advantage provider manual. Kentucky medicaid provider manual wellcare health plans prescribed drugs including mentalbehavioral health drugs, dentures, and providers may also print andor save copies of the authorization form. Guidelines for submitting hedis flat files, esd, and active dx codes. Wellcare s corporate office is located in tampa, florida. Dec, 2020 provider manual get detailed health plan information on important topics such as coverage procedures and policies. Thank you again for being a trusted wellcare provider partner. We understand that maintaining a healthy community starts with providing care to those who need it most.
Thank you again for being a trusted wellcare provider. We explain what each part of medicare covers and how to choose the best ones for you. Remember, members id cards should continue to drive the process you adhere to when you call for eligibility or have claims questions. Jeff rose, cfp june 24, 2020 jeff rose, cfp june 24, 2020 medicare is the united states federally a. Wellcare georgia provider manual pdf sbus6 wgpm 10 this type of wellcare georgia provider manual can be a very detailed document you will mustinclude too.
Where can you find a list of eyeglass providers who accept medicare. We hope you find it a useful resource, and the areas highlighted to the right are sections of the manual that directly address our mutual goal of delivering quality care. For your convenience, items on this qrg in bold, underlined fonts are hyperlinks to supporting wellcare provider job aids, resource guides and forms when the quick reference guide is viewed in an electronic format. Find a provider notice of nondiscrimination wellcare health plans, inc. Member refers to a person eligible and enrolled with easy choice health plan to receive covered services in this provider manual. Wellcare of new hampshire partners with providers to develop and deliver highquality, costeffective health care solutions. January 12, 2017 version 2 page 5 of 108 provider services. Schedule your preventive care visit medicare preventive care visits, or routine checkups, are important to your health. At wellcare we value everything you do to deliver quality care to our members your patients. This manual serves as a guide to the policies and procedures governing the administration of wellcare s medicaid plans and is an.
Wellcare health plans medicare advantage provider manual provider services tollfree. Medicare provides healthcare coverage to people over age 65 and those. This impressive figure demonstrates the importance of that governmentfunded health insurance for people age 65 or with certain health conditions. Wellcare provider portal portal chat ivr interactive voice response.
When it comes to the ins and outs of medicare, picking the right plan leaves you with a lot to think about. For texas dentists texas state dental plans dentaquest. Guide to using selfservice features in the provider portal. Health pl a wellcare company thank you for your participation in the easy choice health plan, a wellcare companys provider network. The local provider and the patient can see a consulting provider remote in real time using medical cameras and video conferencing equipment. Texas hhsc dental services medicaid and chip office reference manual. Wellcare supports local philanthropic events and are avid preventive care advocates. Wellcare and peach state health plan are joining together. Wellcare members can be confident theyre in good hands. Please refer to your provider manual, section 14, dualeligible members, to determine the best process for your area. This notice is to clarify a segment of wellcare s payment policy language applicable to all wellcare medicare markets. This page provides useful information and resources for our medicaid providers.
Wellcare of kentucky partners with providers to develop and deliver highquality, costeffective health care solutions. Office reference manual please refer to your participation agreement for pla ns you are contracted for meridian health plan o f michigan wellcare medicare plan healt hy michigan plan meridian complete medicaid pr egn ant women medicare michigan, ohio, and indiana po box 2906 milwaukee, wi 532012906 8448 703 977 kwwsv dentaquest. Oct 01, 2020 find a provider notice of nondiscrimination wellcare health plans, inc. This guide can help you understand medicare and medicare advantage plans in massachusetts, eligibility for medicare plans, enrollment resources, and helpful tips for enrollment. Texas driscoll childrens health plan office reference manual.
Partners in quality care sincerely, partners in quality care dear provider partner. Change healthcare, formerly known as relay health, manages all edi claims between wellcare and providers. Access materials that are available to assist wellcare providers. This varies depending on the arrangement with the state. Mar 05, 2021 the meridian complete of illinois provider manual has everything you need to know about member benefits, coverage, and guidelines. Original medicare comes in two parts, a and b, that pay for different healthcare services and procedures. Please see your provider manual for complete information on how to refer a member. By using our provider portal instead of calling to speak with a live agent, you are allowing our live customer service teams to prioritize services for providers who are actively assisting our most critical members during the pandemic. Medicare is the united states federally administered health care program. Wellcare s payment policies are based on publicly distributed guidelines from established industry sources such as the centers for medicare and medicaid services cms, the american medical association ama, state health care agencies and medical specialty professional. Wellcare offers integrated case and disease management programs specifically designed to assist with behavioral health issues such as depression and diabetes. January 1, 2020 page 7 of 6 a paper copy of this manual is available at no charge to providers upon request.
Did you know that a new person becomes eligible for medicare every eight seconds. This section covers the different parts of medicare, medicare managed care plans, medigap insurance, and medicare prescription drug coverage. An appointment is scheduled through the gpt scheduling center with a wellcare participating specialist. Medicare health insurance is available in west virginia when y.
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