For Providers

The Annual Enrollment Period for your Medicare patients runs from October 15 to December 7. Your patients have a choice in their Medicare health insurance, and we hope that they will use the 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.

Special Supplemental Benefits for the Chronically Ill (SSBCI) can be offered to Medicare Advantage (MA) members who have one or more complex chronic conditions, are at high risk for hospitalization or adverse health outcomes and require intensive care coordination. SSBCI aims to improve overall health outcomes for the chronically ill population by addressing social needs beyond traditional medical care such as food, housing, transportation, and gaps in care. The program is designed to support individuals by offering additional services beyond standard Medicare coverage.

Members must qualify for SSBCI benefits

Members must meet all three criteria to qualify:

  • The member must require intensive care management.
    • The member must have a history of frequent outpatient services or specialty care and/or, evidence of poor disease control or medication adherence and/or, social or behavioral factors impacting health outcomes. 
  • The member must be at high risk for unplanned hospitalization.
    • The member must have a history of frequent hospitalizations or ED visits related to the chronic condition.
  • The member must have a documented and active diagnosis for a qualifying chronic condition.
    • The chronic condition must be life threatening or significantly limit the overall health or function of the member.

How to Determine Eligibility

Auto Eligibility Process: We utilize internal and claims data in our  internal algorithm to identify members that meet the three criteria. This automatic process refreshes weekly, and links member data across time and health plans, enabling a comprehensive view of historical claims. This process includes all members enrolled in an SSBCI-eligible plan.

Manual Eligibility Process: We may not have claims data or medical records for new members early in the year. These members can go through the manual process to have a provider attest to their eligibility.

To begin the SSBCI manual eligibility process, members must schedule an in-person office visit or contact their healthcare provider to request the attestation be completed. If an office visit is required to complete the attestation, the provider will evaluate the member’s health status during the visit and determine if they meet SSBCI criteria. 

Provider Instructions for SSBCI Attestation

Providers should follow these steps to complete the attestation:

  1. Visit  ssbci.rrd.com.
  2. Review the eligibility criteria outlined on the site (see criteria above) and evaluate the member accordingly.
  3. Submit an attestation through the website confirming the member meets SSBCI eligibility requirements.
  4. Submit a claim from the office visit that includes the appropriate diagnosis codes indicating the member has one or more What Happens Next?qualifying chronic conditions listed on ssbci.rrd.com.

What Happens Next?

Once the attestation is received:

  • The member will receive an approval or denial letter within 10 business days.
  • If approved, the letter will include details about the specific SSBCI benefits available and instructions on how to access them.

Provider Training

There are not any webinars scheduled at this time, but please visit NIA’s website (RadMD) for lots of helpful resources such as Quick Reference Guides, FAQs, and training presentations.

RADMD | WellCare Medicare

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.

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

CAHPS and HOS Resources

Provider News

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Forms and Resources

Please see our Provider Forms and Resources page.