Click here to decrease font size
Text Size
Click here to increase font size
 

Provider

 

5010 Implementation
 
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, but in alignment with CMS’ grace period on enforcement action, WellCare will allow both 4010 and 5010 transactions to be submitted until June 30th, 2012. Click here for more information.

 

Notice to Providers – April 1, 2012 PeachCare for Kids® Rate Changes

Effective for dates of services on and after April 1, 2012 an increase has been instituted for physician service provider rates paid for selected Evaluation and Management (E&M) codes billed for Peach Care for Kids® members.

 

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. Please see the provider notice and FAQs for more information.


General Information

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.

 

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.
 

 

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.

 

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.

All links associated in the section above require the ability to open .pdf files. If for any reason you are not able to view these links, please download the reader software.

provider_unsecured 2008-02-22

 

WellCare Websites