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5010 Compliance

The Administrative Simplification Provision of the Health Insurance Portability and Accountability Act (HIPAA) requires standards for electronic transactions, such as claims (including pharmacy), remittance, eligibility and claims status. The current versions of these standards, X12 Version 4010/4010A1 and NCPDP Version 5.1 will be replaced with Version 5010 and Version D.0, respectively. The federally mandated compliance date is January 1st, 2012. Click here for more information.

Notice to Providers – July 2011: Important Changes in Electronic Data Interchange (EDI) Process

As of July 24, 2011, WellCare Health Plans, Inc. (WellCare) will begin accepting electronic claims only through RelayHealth’s pre-adjudication platform.

We have requested our previous partners to migrate for FREE their EDI connection for WellCare claims to RelayHealth’s pre-adjudication platform. Although most have agreed, some will no longer accept or send transactions to WellCare upon our switch to RelayHealth on July 24, and you may experience unnecessary problems in adjudication or payment of the claims.

In most cases the transition will be seamless; however we strongly encourage you to contact your practice management vendor, billing service or clearinghouse immediately and obtain their assurance as to continued electronic claims submission to WellCare via RelayHealth on and after July 24 to ensure your practice is prepared for this transition.

If you have any questions regarding submission of EDI transactions through RelayHealth, you may call 888-743-8735 and they will provide you assistance and recommendations regarding the transition. For further details, you may contact us via email at EDI-MASTER@wellcare.com. WellCare will respond to those emails in a timely fashion.

Please see the provider notice and FAQs for more information.

Notice to Providers – January 3, 2011: Web Enhancements

The Plan wants to make you aware that we are making enhancements to the Provider and Resources pages. You may experience occasional instances where provider links are not accessible. We are working through this situation and should have the updates completed soon.

Thank you for the quality service you provide to our members. If you have any questions, please do not hesitate to contact the Provider Service Center. Please refer to your Quick Reference Guide for your state-specific telephone number and hours of operation which is available on the Resources page.

Thank you for your interest in our plan. WellCare understands that maintaining a healthy community starts with providing care to those who need it most. As the largest Medicaid and Medicare only contractor in the nation, we offer affordable healthcare plans to individuals eligible for government-sponsored programs.

As the State of Georgia transitions from a fee-for-service arrangement to managed care, we know you may have some questions. Whether you are currently a participating provider or just seeking more information on the services we provide, we are here to help.

We have provided some basic information on managed care as well as who we are to get you started.

          All About WellCare
          Medical Management Objectives
          PaySpan Health - EFT/ERA Services
          Provider Responsibilities
          What is Managed Care?
          WellCare Web Capabilities

Georgia Families Program

Customer Service Representatives are available by calling (866) 231-1821.

WellCare, Medversant Partner to Develop Online Credentialing Tool

In order to save our providers time and reduce their administrative costs, WellCare Health Plans, Inc. recently partnered with Medversant, an NCQA-certified and URAC-accredited Credentialing Verification Organization (CVO) to customize ProviderSource™, an online credentialing portal that will be specifically catered to each of our provider's unique specialties and needs. Designed to provide an efficient, user-friendly experience, ProviderSource™ will offer you the following benefits:

A paperless networking and credentialing application that's custom-tailored to your distinct area of expertise, thanks to a comprehensive professional profile that serves as a secure, universal credentialing and enrollment application, and provides access to provider-specific peer networking, blogs, and news feeds
24/7 access to your credentialing application, meaning you can access the site when it's most convenient for you
One-stop credentialing, including an electronic attestation signature that eliminates the need for multiple applications with the same information and wasteful, unnecessary record-keeping
Access to an infinite electronic research library
Continuous electronic verification of provider credentials and updating of your profile through AutoVerifi™, patented technology created and exclusively provided by Medversant

Please expect an outreach from Medversant to initiate the initial or re-credentialing process for WellCare.

WellCare Providers

The key to using our system is knowing your Provider ID number. This number is issued to each provider and can be found on your provider agreement. It also appears on every Explanation of Payment (EOP) you receive from us. Be sure to have your Provider ID number handy when calling WellCare. It will allow you faster access to our Interactive Voice Response (IVR) system and will aid our customer service representatives in responding to your inquiries quickly.

If you don't know your Provider ID number, contact your local Provider Relations Representative.

H1N1 Flu Information

2009 H1N1 flu (sometimes called “swine flu”) is a new influenza virus that is spreading worldwide. Because this virus is very different from current seasonal influenza viruses, many people will not have protective immunity against it, and the seasonal flu vaccine will not protect against it.

Influenza is unpredictable, but this flu season could be worse than recent years because of the 2009 H1N1 virus. CDC is preparing for an early flu season and expects both 2009 H1N1 flu and seasonal flu to cause illness, hospital stays and deaths this season. Click here for more up-to-date information.

Are You NPI Compliant?

Compliance with the National Provider Identifier (NPI) mandate is critical. As of May 23, 2008, claims submitted to WellCare, and/or designees of WellCare, must comply with the requirement to use only the National Provider Identifier (NPI) on standard transactions.

Click Here to View WellCare's NPI Policy and for instructions for submitting your NPI to WellCare.

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