Wellcare supports local philanthropic events and are avid preventive care advocates. September 30, 2014, wellcare served approximately 4 million members. Wellcare recommends the following billing guidelines for hpv co testing. Wellcare of kentucky partners with providers to develop and deliver highquality, costeffective health care solutions. July 12, 2019 page 6 of 125 2019 wellcare of kentucky provider manual table of revisions date section comments page change 7122019 section1. Jul 12, 2019 wellcare has updated the kentucky medicaid provider manual, effective july 12, 2019. Our dsnps have contracts with state medicaid programs. May 15, 2019 provider billing instructions are displayed in adobe acrobat formats. Mail handlers benefit plan timly filing limit the claim must submit by december 31 of the year after the year patient received the service, unless timely filing was prevented by administrative operations of the government or legal incapacity. Overview eligibility core benefits and services, and extra benefits for members. Commonwealth of kentucky ky medicaid provider billing. By using our provider portal instead of calling to speak with a live agent, you are allowing our live customer service teams to prioritize services for providers who are actively assisting our most critical members during the pandemic. Thank you again for being a trusted wellcare provider partner.
Wellcare of kentucky, inc finance and administration cabinet. Aug 22, 2017 providers with mco questions should contact the respective mco provider services. Billing instructions are for fee for service ffs providers only. Anthem health plan, and wellcare of kentucky are national, forprofit plans. Wellcare provider payment dispute request form 2020 fill. Take care of your behavioral health medicaid we know that when times are tough, it can help to talk to someone. Wellcare of kentucky provider manual department for behavioral. Wellcare partners with providers to give members highquality, lowcost health care and we know that having a healthy community starts with those who need it most. Medicare is a federal program, identified as title xviii, basically serving persons sixtyfive 65 years of age and older, and some disabled persons under that age. Behavioral health c laims are submitted on a hcfa 150 0 form. Wellcare attached copies of the participating provider agreement with harrison memorial entered into in february 2012 as well as wellcare s kentucky medicaid provider manual.
The wellcare website has multiple resources which includes instructions for claims submission. This provider manual is intended for medicaid providers that are contracted with wellcare and provide healthcare services to wellcare members enrolled in a wellcare medicaid managed care plan. In january 2014, kentucky expanded managed care through an alternative. Harrison memorial filed a response in opposition to wellcare s motion and filed its own crossmotion for summary judgment seeking the relief it requested in its complaint. Providers who use availity as their clearinghouse can now electronically submit fee for service.
May 5, 2014 general billing instructions for paper claim forms. The kentucky medicaid program, title xix, shall not be confused, with medicare. Wellcare of kentucky behavioral health claims system re. Fill in all of the necessary fields they are marked in yellow. Best wellcare doctors near me get virtual care zocdoc. Wellcare members can be confident theyre in good hands. The enclosed provider manual is your guide to working with us. Commercial insurance coverage this does not include medicare. May 05, 2014 providers with mco questions should contact the respective mco provider services.
Additionally your provider manual contains specific information regarding the claims submission process. The kentucky medicaid program serves eligible recipients of all ages. As of january 1, 20, wellcare of kentucky has expanded into region 331 and avesis will administer the. Below are the wellcare free edi submission options in. This page provides useful information and resources for our medicaid providers. Get fit without the gym medicaid it might seem hard to find the time or energy to work out. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots. Complete wellcare provider payment dispute request form within a few minutes following the recommendations listed below. Kentucky medicaid provider manual wellcare health plans prescribed drugs including mentalbehavioral health drugs, dentures, and providers may also print andor save copies of the authorization form. Provider type pt the first two digits of the ky medicaid provider number. If you are a medicare or pdp member, please log in here. Commonwealth of kentucky provider billing instructions for. Please note that all providers will need a kentucky medicaid member. Zocdoc is a free online service that helps patients find wellcare doctors and book appointments instantly.
Passport health plan at 18005780775, wellcare of kentucky at 18773899457, humana caresource at 18558527005, anthem blue cross blue shield at 18008802583, or aetna. Additionally, wellcare forms partnerships designed to strengthen the network of resources. Please include a signed appointment of representative form cms1696 or equivalent notice. Find a provider notice of nondiscrimination wellcare health plans, inc. Visit our provider portal at providerportal for additional information about the program and to enroll in eft. May 14, 2020 wellcare partners with providers to give members highquality, lowcost health care and we know that having a healthy community starts with those who need it most. Wellcare connects our members with resources that assist them with everything from housing to transportation to child care, paving a path toward better health and independence. Wellcare partners with providers to give members highquality, lowcost health care. Oct 01, 2020 find a provider notice of nondiscrimination wellcare health plans, inc. Wellcare of georgia partners with providers to develop and deliver highquality, costeffective health care solutions. The name of the referring, ordering or supervising provider is entered in box 17.
Wellcare s comprehensive payment solution ensures that claims process and pay accurately. The updates include various regulatory policy changes implemented by the department of medical services since 2016. You can search for wellcare doctors by symptom or visit reason. List of covered services or authorization requirements under wellcare of kentucky health plans, inc. Wellcare will evaluate the request based on applicable medical criteria, fda. Transmit a primary care provider pcp enrollment file to the. The following are exceptions to the january 1, 2014, reimbursement guidelines and will be reimbursed at 90 percent of the kentucky medicaid fee schedule. We hope you find it a useful resource, and the areas highlightedto the right are sections of the manual that directly address our mutual goal of deliveringquality care. The updates include various regulatory policy changes. Enrollment in our plans depends on contract renewal. Please enter the information below and click the next button. Change healthcare, formerly known as relay health, manages all edi claims between wellcare and providers.
Choose the get form button to open it and start editing. Effective 1112019, we will introduce new coding integrity reimbursement guidelines based on industry standards, coding rules published within the medicare claims processing manual. This provider manual is intended for wellcare contracted participating medicaid providers providing health care services to wellcare members enrolled in a wellcare medicaid managed care plan. Per cms guidelines, to deny claims for hpv codes 87623, 87624, 87625, g0476 for asymptomatic women with a diagnosis of. For accommodations of persons with special needs at meetings, call 1877my wellcare tty 711. Wellcare has updated the kentucky medicaid provider manual, effective july 12, 2019. Below are the wellcare free edi submission options. Pick the document template you want from our collection of legal form samples. Our selfservice channels are the best way to fight the coronavirus covid19. Wellcare resources providers have access to a variety of easytouse reference materials at.
Ky medicaid provider training orientation printable. These instructions are intended to assist persons filing claims for services 1. Complete each section legibly and completely include any additional necessary medical records. Staywell offers different kinds of treatment services across the state of florida. Le, and the more than 69,000 providers nationwide who already partner with wellcare, please send us your information by completing our online form. We understand that maintaining a healthy community starts with providing care to those who need it most. These changes are not material and do not affect existing provider agreements. Overview about wellcare wellcare health plans, inc.
509 340 1112 1114 221 1317 168 628 670 1 637 293 824 1367 1138 42 1261 600 971 969 1134 678 60 40 167 1625 225 388 458 1323