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Provider : Resources

Click the links below to access provider resources such as online claim transaction guides, manuals/handbooks and newsletters. These resources will assist you in working with WellCare of Georgia.

Important Benefit Information

WellCare provides certain benefits and services specified by federal requirements for health plans administering to Medicaid members.

1. WellCare allows women direct access to in-network women's health specialists for covered routine and preventive health care services.

2. WellCare provides for a second opinion from an in-network provider or arranges for the member to obtain a second opinion outside the network.

3. If WellCare is unable to provide a necessary and covered service to a member in-network, Wellcare must adequately and timely cover these services out-of-network, for as long as WellCare is unable to provide these services.

4. If WellCare approves a member to go out-of-network because it is unable to provide a necessary and covered service in-network, WellCare coordinates payment with the out-of-network provider and ensures that the cost to the member is no greater than it would be if the services were furnished in-network.

5. WellCare requires the hours of operation that providers offer to Medicaid members to be no less than those offered to commercial members.

Planning for Healthy Babies (P4HB)
Planning for Healthy Babies (P4HB) is a program that provides no‐cost family planning services to eligible women in Georgia. It also provides women who have delivered a very low birth weight (VLBW) baby with inter‐pregnancy care services, which include primary care, substance abuse treatment and a case management, including Resource Mother outreach.

Please reference the documents below for more information:

P4HB Provider Notice (January 24, 2011)
P4HB Provider Job Aid
P4HB Benefit Coverage

Information for Non-participating Providers
Please note that all of the information listed on this page applies to both participating (in-network) providers and to non-participating (out-of-network) providers.

The links below are specifically geared to non-participating providers:

Claims Updates
This page provides updates on WellCare's claims processes, ensuring that provider claims are handled efficiently.

Clinical Coverage Guidelines
Clinical Coverage Guidelines (CCG) are evidence-based documents detailing the medical necessity of given procedures or technologies. The guidelines set consistent criteria for the coverage of a procedure or technology, leading to greater consistency and efficiency in clinical decision making.

Forms & Documents
This section is a repository of forms and documents to be used by all providers and institutions when managing care for our members.

Fraud & Abuse
The link provides access for reporting suspected fraudulent and abusive practices by providers and members of the Medicaid and PeachCare for Kids programs. Learn how to recognize possible fraud and program abuse and report suspicious activities. For your privacy you may remain anonymous.

Hospital Services Handbook
The Hospital Services Handbook is a resource for institutions that outlines WellCare guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide and the online tools available through the secured area of this Web site.

Pharmacy Services
Click the link to receive information about our available Pharmacy Services, and view the latest Preferred Drug List.

Provider Handbook
The Provider Handbook is a resource for physicians with guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide and the online tools available through the secured area of our Web site.

Provider Quick Reference Guide pdf
The Quick Reference Guide is a resource that contains WellCare contact information and authorization guidelines. Please refer to the version on this site to ensure you are using the most current information.

Provider Job Aids
Job aids are step-by-step work instructions on how to perform daily tasks with WellCare.

Provider Training Resources
Provider Training Resources supply educational tools regarding initiatives that require specific actions by providers.

Provider Newsletters

The links above require the ability to open .pdf files. If for any reason you are not able to view these links, please click here to download Adobe Reader.