This provider manual is intended for wellcarecontracted participating. Wellcare of kentucky medicaid quick reference guide may 2015. All claims are dependent upon a valid diagnosis code being submitted. Apply to become a health care provider for wellcare. If you have questions or need more information about a. Kentucky medicaid identifies community mental health centers cmhc provider type 30. Finance medicare kentucky wellcare member handbook. Wellcare kentucky health insurance exchange provider manual effective. Aetna better health of kentucky 2017 provider manual. Failure to include icd10 codes on claims filed on or after oct. Wellcare supports local philanthropic events and are avid preventive care advocates. We are pleased with our fourth quarter and fullyear 2015 results, said kenneth a. Cabinet jun 29, 2015 passport health plan and wellcare of kentucky, inc.
We will continue to supply our providers with updates via letters, fax blast, the provider website, newsletters and contact with provider relations representatives as changes occur. Wellcare has updated the kentucky medicaid provider manual, effective july 12, 2019. It is also important to know that wellcare of south carolina uses a preferred drug list pdl. Provider manual therapy network of georgia claims submission protocols and standards. This manual serves as a guide to the policies and procedures governing the administration of wellcares medicaid plans and is an. Harrison memorial filed a response in opposition to wellcares motion and filed its own crossmotion for summary judgment seeking the relief it requested in its complaint. Ask your primary care provider pcp about which tests and screenings are right for you. Overview about missouri care since 1998, missouri care, a wellcare company, has worked with the mo healthnet division. For your conveni ence, items on this qrg in bold, underlined fonts are hyperlinks to supporting wellcare of kentucky provider job aids, resource guides and forms when the quick reference guide is viewed in an electronic format. The drugs on the pdl are organized by brand and generic name. This document is designed to guide you through aetna better health of kentuckys administrative processes. To enroll and bill kentucky medicaid, cmhc service providers must be. Effective august 1, 2015, an ncqa certified centralized credentialing verification organization, will be responsible for credentialing georgia medicaid providers seeking to enroll with wellcare of georgia. Wellcare health insurance company of kentucky, inc.
Community mental health centers cmhc pt 30 cabinet. As of june 30, 2015 of the wellcare health insurance company of kentucky, inc. Pharmacy obtain medicare authorization must be checked on the form sections a, b, c, or d, wellcare classicwellcare signature. Health check services epsdt all preventive or wellchild services, except normal newborn care in the hospital, must be billed under the health check program following the policies and procedures as outlined in the wellcare providers manual. For your convenience, items on this qrg in bold, underlined fonts are hyperlinks to supporting wellcare provider job aids, resource guides and forms when the quick. Wellcare attached copies of the participating provider agreement with harrison memorial entered into in february 2012 as well as wellcares kentucky medicaid provider manual.
Provider manuals a complete copy of wellcare s provider manual is available online, including all of the necessary forms and educational materials. Wellcare kentucky health insurance exchange provider manual florida. For more information, refer to the quick reference guide. The updates include various regulatory policy changes.
Kentucky medicaid identifies physician service providers as provider type 64 individual or 65 group. The welcome letter includes the lines of business you are contracted with and effective dates. Wellcare s medicaid managed care services allow flexibility and offer a distinct set of. The deadline for provider revalidation to prevent suspension from the aforementioned medicaid programs was april 1, 2015. Claim filing manual providers select health of south carolina.
Medicaid provider manual provider participation in the quality improvement program. Wellcare health plans is now part of centene, which operates as fidelis care in new york state. You will need it when registering for the secure provider portal and for managing your business with wellcare. Wellcare expands medicaid benefits in kentucky to encourage. Commonwealth of kentucky kentucky cabinet for health. For dates of service on or after october 1, 2015, electronic claims. For a list of participating medical providers please see the kentucky medicaid provider directory. Purpose of this manual this provider manual is intended for wellcarecontracted participating medicaid providers providing health care services to wellcare members enrolled in a wellcare medicaid managed care plan.
Wellcare is committed to making sure your wellbeing thrives by caring for you in every area of your life physically, emotionally and socially. Mailing addresses general mailing address wellcare health plans. Practices and procedures manual except to the extent that. Page 10 kentucky medicaid pharmacy provider pos billing manual 1. Pharmacy services wellcare of south carolina will pay for the drugs that medicaid requires you to have. Illinois medicaid provider manual 20142015 wellcare. How to search the blue cross complete provider manual. Providers may contact their local market office for assistance.
Health plan at 18005780775, wellcare of kentucky at kentucky medicaid vision program manual kentucky. In order to enroll and bill kentucky medicaid, physician service providers must be. 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. We are committed to quality service and partnership with providers to ensure members get the most of their benefits. Government of the united states and the commonwealth of kentucky. The pdl is a list of drugs that we prefer your doctor use. Wellcare advocate complete fida provider manual effective.
In kentucky, physician service providers must be licensed with the kentucky board of medical licensure. Eligibility for kentuckys medicaid program is solely determined by the. This document contains information about the drugs we cover in this plan. Aug 19, 20 kentucky medicaid provider manual wellcare health plans this provider manual is intended for wellcarecontracted participating medicaid providers providing health care services to wellcare members enrolled in a. Aug 01, 2015 effective august 1, 2015, an ncqa certified centralized credentialing verification organization, will be responsible for credentialing georgia medicaid providers seeking to enroll with wellcare of georgia. Our selfservice channels are the best way to fight the coronavirus covid19. As a result of the patient the kentucky medicaid member handbook also provides an 2016 managed care program progress report kentucky. Wellcare members can be confident theyre in good hands. Commonwealth of kentucky court of appeals us case law. Reserve or upgrade your advertising for the 2016 finding long term.
Effective october 1, 2015, eops can be viewed andor downloaded and. Cabinet wellcare of kentucky continues to have the largest. Guide to choosing a medicaid health plan kentucky cabinet for not all healthcare providers accept all plans. Commonwealth of kentucky ky medicaid provider billing may 5, 2014 general billing instructions for paper claim forms. Passport health plan at 18005780775, wellcare of kentucky at 18773899457. The plan provides integrated medical and behavioral health services for members. In kentucky, cmhc service providers must contact the office of inspector general division of health care for a surveylicense. Texas appendix to the humana provider manual, effective feb. Ratings help you know how good of a job our plan is doing. Tennessee appendix to humana provider manual for health care providers and the humana medicare advantage dual eligible special needs plans, pdf opens in new window. About wellcare ohana health plan the plan, a health plan offered by wellcare health insurance of arizona, inc. Accessing our website, at kyprovidersmedicaid, is quick and easy. Wellcare selects the drugs by working with a team of health care providers. Select health of south carolina claim filing manual 3.
Overview eligibility core benefits and services, and extra benefits for members services not covered by wellcare of kentucky 10 1015 16 eligibility categories updated benefits and services updated new section added. Finding longterm care in the bradd 2015 kentucky legal aid. Wellcare goes beyond basic medicare with valuable extra benefits. Wellcare medicare advantage plans offer extra benefits to take care of all aspects of your health. Texas appendix to the humana provider manual, effective july 1, 2020, pdf opens in new window. 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. Kentucky medicaid pharmacy provider pointofsale pos. Kentucky medicare quick reference guide january 2015 web.
This guide will explain the services that wellcare offers to assist with those routine tasks. Download provider manuals for professionals, facilities, and others for more on our programs and policies. Kentucky medicaid provider resource guide wellcare of kentucky, inc. Care provider administrative guides and manuals the following links provide information including, but not limited to, prior authorization, processing. You have or will receive a welcome letter with your provider id or network identification number.
For healthy michigan plan members enrolled prior to may 1, 2015, the healthy michigan plan. Wellcare provides behavioral health benefits to members enrolled in georgia medicaid plans. If your preferred contact information is incorrect, access your gammis account to update or submit to hp the medicaid peachcare provider information change form to prevent future mailing issues. The online tools allow providers the opportunity to research routine. Did wellcares preauthorization policy andor guidelines for requesting preauthorizations change with the implementation of icd10. Wellcare partners with providers to give members highquality, lowcost health care. In 2015, we improved the performance of each of our lines of business, successfully secured our kentucky and georgia medicaid contracts and meaningfully improvedour balance sheet. Kentucky medicaid provider manual wellcare health plans this provider manual is intended for wellcarecontracted participating medicaid providers providing health care services to wellcare members enrolled in a.
Wellcare has the ability to autoadjudicate icd10 claims in the same manner we autoadjudicated icd9 claims. Physician administered drug pad list pharmacy branch 502 5646890. Wellcare understands that having access to the right tools can help you and your staff streamline daytoday administrative tasks. Department for medicaid services kentucky cabinet for health. National provider identifier npi, tax identification number tin or tax id and. Search the online wellcare provider directory by geographic location and medical specialty to refer members to innetwork services. Hipaacompliant cpt or healthcare common procedure coding. Anthem provides health care professionals with supporting resources to help your relationship with us run as smoothly as possible. Le, and the more than 69,000 providers nationwide who already partner with wellcare, please send us your information by completing our online form. June 2, 2015 page 6 of 96 teamwork with our fellow associates, we can expect and are expected to demonstrate a collaborative approach in the way we work.
This page provides useful information and resources for our medicaid providers. This provider manual is intended for wellcarecontracted participating medicaid providers providing health care services to wellcare members. Ohana health plan the plan, a health plan offered by wellcare health insurance of arizona, inc. Passport health plan at 18005780775, wellcare of kentucky at 18773899457, humana. Tennessee appendix to the humana provider manual, effective aug. June 2, 2015 page 6 of 96 teamwork with our fellow associates, we can expect and are expected to demonstrate.
This manual replaces and supersedes any previous versions prior to the departments approval date of march 25, 20 and is available on wellcare s website at. Commonwealth of kentucky ky medicaid provider billing. The kentucky medicaid vision program manual provides medicaid providers accepts this payment in accordance with the departments fee structure, the. All participating providers who create a login and password using wellcares provider identification. Date section comments page number ohana health plan provider manual. Blue cross complete provider manual pdf blue cross blue shield.
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