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Provider : Frequently Asked Questions

To help answer some of the most frequently asked questions we receive from providers and members, please see below.

If you have a question that isn’t listed here, or if you need additional information, please call the Provider Hotline at (866) 231-1821.

NEW - Frequently Asked Questions regarding the recent Medicaid Care Management Organization Actpdf (House Bill 1234).

FREQUENTLY ASKED QUESTIONS FROM PROVIDERS

Q: I don't know my Provider ID number. Where can I find it?

A: Your Provider ID number was included in the welcome materials you received from WellCare when you first became a participating provider. It can be found on any Explanation of Payment (EOP) you receive from WellCare or by calling your local Provider Relations Representative. You should keep your Provider ID number where it can be easily accessed when calling WellCare.

Q: How can I ensure I am receiving the most current eligibility information?

A: WellCare receives downloads from the State of Georgia on the first of every month. It is important to verify eligibility via the web as close to the appointment date as possible to ensure you receive the most current information available.

Q: How can I file my claims electronically?

A: Filing claims electronically is the fastest and most efficient way to submit claims to WellCare. Currently, WellCare receives electronic claims from four clearinghouses: WebMD, SSI Group and ACS EDI Gateway. Contact us at (866) 231-1821, Option 2 then Option 4 for details on filing claims electronically.

Q: How long does it take to get a claim paid?

A: The Georgia Families program requires the processing of clean claims within 15 business days. Ensuring the claims you submit include all of the necessary information can aid us greatly in processing claims quickly. Claims that are missing information or include inaccurate information will result in delays. It is important to use the same vendor information (i.e., name of provider/practice, Tax ID numbers) that is submitted on your W-9 form as filed with the IRS. Simply using a slightly different version of the name of your practice can delay the processing of your claims. Using invalid or dated CPT codes can also delay processing.

Q: What functions are available through georgia.wellcare.com?

A: WellCare offers secure web access to participating providers. Functions available include the ability to check member eligibility and co pay information,to request authorizations, to file claims,and check the status of submitted claims. Our provider directories and handbooks are also available online. Providers must register with their WellCare-assigned Provider ID number to gain access. Each registered provider may assign Administrative Users within their practice who will oversee all additional WellCare website users (Subusers).

To register, log on to http://georgia.wellcare.com/Provider/WhyRegister and follow the simple steps. Once that process is complete, you will receive your user ID and password via email.

FREQUENTLY ASKED QUESTIONS FROM MEMBERS

Q: I've lost my member ID card. How can I get a replacement?

A: Members should call WellCare Customer Service at (866) 231-1821 (TTY/TDD (877) 247-6272 to request a replacement WellCare ID card. To replace a Medicaid card, members should call their caseworker at the Georgia Department of Family and Children Services.A: With the Georgia Families plan, members do not need a referral for an initial visit to a specialist. However, if follow-up visits are necessary, you will need to obtain a referral from your Primary Care Physician (PCP). It is important that members discuss their care options with their PCPs.

Q: Where can I get my prescriptions filled?

A: Prescriptions written by network providers must be filled at a participating pharmacy. Members can utilize our automated voice response system available through the Customer Service toll free number or logon to georgia.wellcare.com for a list of participating pharmacies. Members can also call WellCare Customer Service at (866) 231-1821 (TTY/TDD (877) 247-6272) to inquire about participating pharmacies.

Q: What is a Preferred Drug List (PDL)?

A: The PDL is a list of medications developed by WellCare that providers use when prescribing medications for members. WellCare will only pay for the medications that are listed on the PDL with a few exceptions. The PDL is updated quarterly. Providers can tell members if a particular drug is on the PDL.

Q: How much do services cost?

A: For some services, there is no cost. However, members are responsible for copays for services such as prescription drugs. Information on covered services and copays can be found in WellCare's Georgia Families Member Handbook.

Q: What happens if I need care over a weekend when your office is closed? Should I go to the emergency room?

A: If it is an emergency, members should proceed immediately to the emergency room for care. If it is not an emergency, WellCare PCPs are available to members 24 hours a day, 7 days a week. After-hours care may be provided by a 24-hour answering service, an answering system with an option to page the physician, or an advice nurse with access to the PCP or on-call physician. Members may also call the WellCare Health Advice Line at (800) 919-8807 which is available to all Georgia members and can help.
 

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