MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
For Providers
Wellcare is ready to become your Medicare partner in 2022! As we prepare to launch our Medicare Advantage plans our January 1, 2022, we want to help you and your patients get to know Wellcare.
The Annual Enrollment Period for your Medicare patients runs from October 15 to December 7, 2021. Your patients have a choice in their Medicare health insurance, and we hope that they will use this Annual Enrollment Period to get acquainted with Wellcare. If they ask you about their coverage options, let them know you accept Wellcare.
As our partner, you can count on our complete support as you continue to focus on providing compassionate and expert care to your patients. Our most helpful provider resources include:
Further provider resources, including dedicated Provider Relations and Contracting contacts, can be found on the Oklahoma Complete Health's website at https://www.oklahomacompletehealth.com/providers.html. Wellcare is the Medicare product offered through Oklahoma Complete Health.
Submit Attestations Online for Chronically Ill Members
Effective January 1, 2023, fax attestations are no longer accepted
Special Supplemental Benefits for Chronically Ill (SSBCI) are offered to Wellcare’s highest-risk members who meet specific criteria for eligibility based on the Centers for Medicare and Medicaid Services (CMS) guidelines.
Effective January 1, 2023, you can check eligibility requirements and submit attestations on behalf of members online at ssbci.rrd.com.
Steps to determine eligibility, submit attestations and activate benefits
Members are required to schedule an office visit with their doctor or participating physician group for evaluation. Once appointment is made follow the steps below:
- Visit ssbci.rrd.com.
- Follow the steps on ssbci.rrd.com to evaluate your patient against the eligibility requirements outlined on ssbci.rrd.com.
- Submit an attestation form through ssbci.rrd.com indicating your patient meets the eligibility requirements.
- Submit a claim with the appropriate diagnosis codes from this office visit indicating a member has been diagnosed with one or more qualifying chronic conditions listed on ssbci.rrd.com.
- Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days. Approval letters include information on steps the member should follow to activate supplemental member benefits.
If you have questions regarding the information contained in this update, contact your dedicated Provider Relations Representative with the health plan.
- Provider Manual (PDF)
- Provider Orientation Booklet (PDF)
- Provider Orientation PaySpan Info Sheet (PDF)
- Provider Orientation Risk Adjustment Tip Sheet (PDF)
- Provider Orientation Secure Portal Instruction Sheet (PDF)
- Provider Orientation Prior Authorization Tip Sheet (PDF)
- Provider Orientation Quick Reference Guide (PDF)
Provider Training
Please look at our Provider Training Page for more information.
The Centers for Medicare & Medicaid Services (CMS) regulations require that health plans provide their Special Needs Plan provider network with information on their basic Model of Care. This applies to our Dual Eligible Special Needs Plan (D-SNP) members, who are eligible for both Medicare and Medicaid.
We have included a self-study program that outlines the basic Model of Care requirements for our providers. We also have included frequently asked questions containing other helpful information.
CMS requires us to educate providers who usually treat our SNP members annually about WellCare’s Model of Care. Annually, we will update the provider training material to align with the current year Model of Care.
Once you have reviewed the training module, please complete the Provider Model of Care Training Attestation.
We ask that you partner with us to ensure we are giving the highest quality of care possible to our SNP members by performing the following steps:
- Review the member care plans WellCare faxes to you
- Update the care plan with any required changes and fax the revised plan back to WellCare Oklahoma at 1-844-222-3180
- Call 1-833-583-0866 with questions or to further discuss the care plan.
- Please keep a copy of the updated care plan to review with the SNP member during the next office visit.
- Participate in the Interdisciplinary Care Team (ICT) for all SNP members and give feedback as appropriate.
- Partner in the transition of care process when a SNP member is admitted and is discharged from an inpatient and/or subacute setting of care.
- Inpatient and subacute providers: During planned and unplanned transitions of care communicate with the next level of care provider, the member’s primary care practitioner or specialist, to share updated treatment plans including: diagnoses, test results, and treatments/procedures performed, discharge instructions and a current medication list to assist with coordination of care.
- Primary Care Practitioners: We will inform you when a member admits to an inpatient and/or subacute level of care when we are notified of this admission. We ask facility and facility providers share the member’s diagnoses, test results, and treatments/procedures performed, discharge instructions and a current medication list. If you have not received this information, please request this information via the electronic health record, if available, or the medical records department at the facility to help update the member’s chart and assist in coordination of care. Complete a medication reconciliation within 30 days of discharge.
We appreciate the quality care you provide to our members and your support of our efforts to meet the CMS regulations regarding the SNP Model of Care.
Not part of WellCare’s Provider Network yet?
We understand that our Members may elect to visit providers that are not part of WellCare’s Provider Network. If you are not in-network, you’ll still need to know how to file claims and understand any policies and procedures that may affect you and your WellCare-member patients.
The resources found on this page contain useful information to help you interact with WellCare.
Interested in joining our Network?
We’re always looking for high-quality providers to help care for our Members.
Helpful Documents
Provider News
Please see our Provider Newsroom page for the most updated news!
Forms and Resources
Please see our Provider Forms and Resources page.