Click the links below to access provider resources such as online claim transaction guides, manuals/handbooks and newsletters. These resources will assist you in working with WellCare. 

• Model of Care Program Online Training
  Effective October 1, 2009, pursuant to the 2008 MIPPA legislation, WellCare has enhanced its Model of Care program for our Medicare Special Needs Plan (SNP) members. As part of our ongoing provider training, please participate in free online training for our Model of Care program. The link to the training may be accessed at www.wellcare.learnsomething.com.

• CMS-Mandated Fraud, Waste and Abuse Training
  The Centers for Medicare & Medicaid Services (CMS) has mandated that all delegated and contracted providers who render benefits or services for Medicare Part C and Part D programs must meet fraud, waste and abuse (FWA) training requirements by December 31, 2009. Click here for more information on how to fulfill this requirement.

• Medicare Members' Co-pay Responsibility in 2010
  Effective January 1, 2010, WellCare Medicare members will be responsible for co-pay amount(s) for certain diagnostic services performed in an outpatient setting.  In some instances, the diagnostic co-pay will be in addition to the facility, or office visit, co-pay. The resources below are meant to help you determine these co-pay responsibilities.

• Co-pay Responsibility Frequently Asked Questions
• Determining Dual-Eligible Member Cost-Share Job Aid
• Determining Member Co-pay Responsibility for Diagnostic Services in 2010 Job Aid

• Claims Updates
  This page provides updates on WellCare's claims processes, ensuring that provider claims are handled efficiently.
           
• Clinical Coverage Guidelines
  Clinical Coverage Guidelines (CCG) are evidence-based documents detailing the medical necessity of given procedures or technologies. The guidelines set consistent criteria for the coverage of a procedure or technology, leading to greater consistency and efficiency in clinical decision making.
   
• Provider Manuals
  The Provider Manual 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 Quick Reference Guides
  Quick Reference Guides are resources that contain WellCare contact information and authorization guidelines. Please refer to the versions on this site to ensure you are using the most current information.
   
• Provider Newsletters 
  WellCare produces newsletters to update providers on information related to pharmaceuticals, cost and quality of care or share tips on how to perform better and more efficient business with the plan. The newsletters are also used to highlight recent successes, such as accreditations and quality scores.
   
• Provider Job Aids
  Job aids are step-by-step work instructions on how to perform daily tasks with WellCare.
   
• Provider Training Materials
  The provider training materials supply our providers with educational resources regarding initiatives that require specific actions by providers.
   
• Medicare Brochures
  These brochures provide valuable information about WellCare's processes and services.  
  All About WellCare
  Case and Disease Management
  PaySpan Health: Health Care Payment and Remittance Advice
  Provider Responsibilities
  What is Managed Care?  
   
• Quality Improvement Provider Toolkits (Florida only)
  The Quality Improvement Provider Toolkits contain useful tools for managing patient care based on industry-standard clinical practice guidelines.
   
• WellCare Web Capabilities 
  This Job Aid gives an overview of the WellCare Web site's capabilities that may be used to further ease your interactions with WellCare.