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Provider

 

WellCare of New York partners with our providers to develop and deliver high-quality, cost-effective health care solutions. We understand that maintaining a healthy community starts with providing care to those who need it most. We are committed to improving the quality of life of our millions of members, who often include some of our nation’s most vulnerable populations. 

 

Please visit our resources page for information, materials and forms to help our provider partners.

 

Join WellCare

Please complete our provider form or contact us for more information on how to join our network.

 

ICD-10 Compliance
WellCare will be compliant with the Centers for Medicare & Medicaid Services (CMS) rule for ICD-10 readiness beginning Oct. 1, 2014. We have compiled important information and Frequently Asked Questions for providers.

 

Behavioral Health Update

Effective December 15, behavioral health services transitioned from Magellan to the WellCare Behavioral Health Integrated Program

 

Website Capabilitiespdf

Our secure Provider Portal offers a variety of ways to manage your account online, including:

 

  • Member eligibility and co-payment information.
  •  Authorization requests and status inquires.
  • Claims submission and status inquires.
  • A personal inbox with direct messages WellCare.
  •  Provider news.
  • Sign up: Individual Provider | Large Group/IPApdf
     

Important Reminders for Participating Providers

All of WellCare’s participating primary care practitioners and OB-GYNs are required to provide access to covered medical services 24 hours a day, 7 days per week.

 

  •  It is critical for you and your team to respond to telephone inquiries in a manner that meets New York Department of Health expectations and enables patients to know that you are a participating WellCare provider.
  •  The correct response to the question, “Does Dr. <<   >>  accept WellCare’s Child Health Plus (CHP)/Family Health Plus (FHP)/Healthy Choice/Medicaid line of business?” should always be: Yes.
  •  It’s important to remember that the Child Health Plus (CHP) program is available for individuals up to 19 years of age.

 

After-Hours Access/Appointment Availability Standards

  • All calls must be returned within 30 minutes by the on-call provider.
  • Members may only be directed to the emergency room for life-threatening conditions.
  • WellCare providers must adhere to the current NYSDOH Access and Availability standardspdf.
Last modified: 02/04/2014
 

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