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Provider : Resources

Access provider resources such as online claim transaction guides, manuals/handbooks and newsletters. These resources will assist you in working with WellCare of Georgia.

DCH Launches Centralized Prior Authorization Portal
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June 1, 2013, DCH will implement the new Centralized Prior Authorization (PA) feature. This feature will allow participating Georgia Medicaid providers to submit PA requests to Fee-for-service (FFS) and Care Management Organizations (CMOs) through one centralized source. A staged development approach will be used so that providers can become familiar with the Centralized PA process.

Please reference the documents below for more information:

 

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®)

Great news! The Planning for Healthy Babies (P4HB®) program is still accepting new participants. Potential participants may apply for the program online, or obtain a paper application at their local health department or DFCS office.

 

The P4HB® program provides no-cost family planning services to eligible women in Georgia. It also provides additional services such as primary care, substance abuse treatment, and case management including Resource Mothers Outreach to eligible women who have delivered a very low birth weight baby.

 

Please review the documents below for more information:  

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 for non-participating providers:
 

 

Authorization Look-Up Tool
Search quickly and easily by CPT code.


Behavioral Health
Information about our behavioral health program, including authorization requirements, case and disease management and more.

  

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

 

Clinical Coverage Guidelines
Evidence-based guidelines detailing the medical necessity of procedures or technologies.

 

Clinical Practice Guidelines
Best-practice recommendations based on available clinical outcome and scientific evidence.
 

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.
 

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

Provider Handbook pdf
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 Relations Contactspdf
Find the name and email address of your provider relations representative.

 

Provider Quick Reference Guides
The Quick Reference Guide is a resource that contains WellCare contact information and authorization guidelines. Please refer to the versions 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 Newsletter
2014

 

2013

The links above require the ability to open .pdf files. If for any reason you are not able to view these links, please download Adobe Reader.
Last modified: 03/28/2014
 

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