Provider : Resources

 

As a WellCare of Florida provider, we want to make things easy for you. The resources on this page will guide you to provider policies, coverage guidelines and claims information.  
 

Adverse Incidents
Important information for reporting quality of care issues, including adverse incidents as defined by the Agency for Health Care Administration (AHCA).

 

Authorization Look-Up Tool
Use our authorization look-up tool to search quickly and easily by CPT code.

Provider Manual
An extension of the Participation Agreement, the Provider Manualpdf outlines health plan coverage procedures, policies and other information related to our members’ health care services. This document should be used simultaneously with the Quick Reference Guide and other resources.

 

Quick Reference Guide
The QRGpdf contains key phone numbers and useful information about claims, appeals and more.
 

Claims Updates
Updates on WellCare's claims processes to ensure your claims are handled efficiently.

 

Clinical Coverage Guidelines
In an effort to help you make efficient decisions, these evidence-based guidelines detail the medical necessity of procedures and technologies to help you set consistent criteria for coverage of procedures or technologies. Note: Please check the Position Statement in each CCG to determine coverage determination for your state/market.

 

Clinical Practice Guidelines
Our best-practice guidelines are used to guide efforts in improving the quality of care in our membership.  CPGs are based on available clinical outcome and scientific evidence-based content developed by expert professional and clinical society recommendations.


Coordination of Benefits
Coordination of Benefits (COB) claims are essential to adjudicating claims correctly. WellCare encourages providers to submit COB claims electronically

 

Forms & Documents
This resource provides template forms and documents for appeals, authorizations, claims, pharmacy services and more.

 

Job Aids and Resources Guide
This guide offers detailed documents and instructions on how to perform daily tasks with the plan.

 

ICD-10 Compliance
WellCare will be compliant with the Centers for Medicare & Medicaid Services (CMS) rule for ICD-10 readiness beginning Oct. 1, 2015. We have compiled important information and Frequently Asked Questions for providers.

 

Training Resources
Access a variety of educational materials designed to help providers meet training requirements

 

Provider Newsletters
WellCare newsletters update providers on information related to pharmaceuticals, cost and quality of care and offers tips on how to improve business with the plan. Our newsletters also highlight recent successes, such as accreditations and quality scores.

 

Florida SHOTS
PCPs must provide all covered immunizations to Florida Healthy Kids members and be enrolled with the Florida State Online Tracking System (SHOTS), Florida’s statewide online immunization registry.

 

Last modified: 02/27/2015
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