MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Wellcare is ready to become your Medicare partner!
The Annual Enrollment Period for your Medicare patients runs from October 15 to December 7. Your patients have a choice in their Medicare health insurance, and we hope that they will use this Annual Enrollment Period to get acquainted with Wellcare. If they ask you about their coverage options, let them know you accept Wellcare.
As our partner, you can count on our complete support as you continue to focus on providing compassionate and expert care to your patients. Our most helpful provider resources include:
- 2023 Wellcare Provider Manual (PDF)
- Provider Orientation Toolkit
Further provider resources, including dedicated Provider Relations and Contracting contacts, can be found on the Nebraska Total Care’s website at www.nebraskatotalcare.com/providers.html. Wellcare is the Medicare product offered through Nebraska Total Care.
- For Non-Duals/C-SNP dial 1-833-542-0693
- For Duals/D-SNP dial 1-833-853-0864
Submit Attestations Online for Chronically Ill Members
Effective January 1, 2023, fax attestations are no longer accepted
Special Supplemental Benefits for Chronically Ill (SSBCI) are offered to Wellcare’s highest-risk members who meet specific criteria for eligibility based on the Centers for Medicare and Medicaid Services (CMS) guidelines.
Effective January 1, 2023, you can check eligibility requirements and submit attestations on behalf of members online at ssbci.rrd.com.
Steps to determine eligibility, submit attestations and activate benefits
Members are required to schedule an office visit with their doctor or participating physician group for evaluation. Once appointment is made follow the steps below:
- Visit ssbci.rrd.com.
- Follow the steps on ssbci.rrd.com to evaluate your patient against the eligibility requirements outlined on ssbci.rrd.com.
- Submit an attestation form through ssbci.rrd.com indicating your patient meets the eligibility requirements.
- Submit a claim with the appropriate diagnosis codes from this office visit indicating a member has been diagnosed with one or more qualifying chronic conditions listed on ssbci.rrd.com.
- Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days. Approval letters include information on steps the member should follow to activate supplemental member benefits.
If you have questions regarding the information contained in this update, contact your dedicated Provider Relations Representative with the health plan.
- Provider Medicine Request Checklist (PDF)
- Prior Authorization Information (PDF)
- Wellcare Health Plans Utilization Review Matrix 2021 (PDF)
- Provider Outreach and Clinical Engagement Strategy for Wellcare (PDF)
- National Imaging Associates FAQ's For Wellcare Providers (PDF)
- National Imaging Associates FAQ's Wellcare Prior Authorization Physical Medicine (PDF)
- Cardiac Checklist (PDF)
- Cardiac Imaging Frequently Asked Questions (PDF)
- Cardiac Solution Program Tip Sheet MPI vs. SE (PDF)
Quick Reference Guides-
Clinical Policy List
- CP.MP.124 ADHD Assessment and Treatment (PDF)
- CP.MP.100 Allergy Testing (PDF)
- CP.MP.96 Ambulatory EEG (PDF)
- CP.MP.110 Bronchial Thermoplasty (PDF)
- CP.MMP.105 Digital EEG Analysis (PDF)
- CP.MMP.50 Drugs of Abuse: Definitive Testing (previously Outpatient Testing for Drugs of Abuse)
- CP.MP.155 EEG in the Evaluation of Headache (PDF)
- CP.MP.106 Endometrial Ablation (PDF)
- CP.MP.134 Evoked Potentials (PDF)
- CP.MP.113 Holter Monitors (PDF)
- CP.MP.123 Laser Skin Treatment (PDF)
- CP.MP.139 Low-Frequency Ultrasound Wound Therapy (PDF)
- CC.MP.181 Polymerase Chain Reaction Respiratory Viral Panel Testing (PDF)
- CP.MP.149 PROM Testing
- CP.MP.97 Testing for Select Genitourinary Conditions (previously Diagnosis of Vaginitis) (PDF)
- CP.MP.154 Thyroid Testing in Pediatrics (PDF)
- CP.MP.38 Ultrasound in Pregnancy (PDF)
- CP.MP.153 H Pylori Testing (PDF)
- CP.MP.157 Vitamin D Testing in Children (PDF)
- CP.MP.99 Wheelchair Seating (PDF)
- CP. MP.143 Wireless Motility Capsule (PDF)
- CP.MP.54 Hospice Services (PDF)
- CC.PP.500 3 Day Payment Window (PDF)
- CC.PP.070 340B Drug Payment Reduction (PDF)
- OC.UM.CP.0026 Extended Ophthalmoscopy (PDF)
- OC.UM.CP.0043 External Ocular Photography (PDF)
- OC.UM.CP.0028 Fluorescein Angiography (PDF)
- OC.UM.CP 0031 Gonioscopy (PDF)
- CC.PP.065 Multiple Diagnostic Cardiovascular Procedure Payment Reduction (MDCR) (PDF)
- CC.PP.069 Multiple Procedure Reduction: Ophthalmology (PDF)
- CC.PP.061 Non-Obstetrical and OB Pelvic and Transvaginal Ultrasounds (PDF)
- OC.UM.CP.0014 Scanning computerized Ophthalmic Diagnostic Imaging (SCODI) (PDF)
- CC.PP.035 Sleep Studies Place of Service (PDF)
- CC.PP.056 Urine Speciment Validity Testing (PDF)
- OC.UM.CP.0063 Visual Field Testing (PDF)
- CC.PP.502 Wheelchairs Accessories (PDF)
- CC.PP.501 30 Day Readmission (PDF)
- CC.PP.066 Leveling of Care: Evaluation and Management Overcoding (PDF)
- CC.PP.053 Non-Emergent ER Services (fka Leveling of ER Services) (PDF)
- CC.PP.054 Physician's Consultation Services (PDF)
- CC.PP.057 Problem-Oriented Visits with Preventative Visits (PDF)
- CC.PP.052 Problem-Oriented Visits with Surgical Procedures
- CC.PP.020 Distinct Procedural Modifiers: XE, XS, XP, & XU (PDF)
- CC.Pl.04 Clean Claim Reviews (PDF)
- CC.Pl.06 Cost to Charge Adjustments on Clean Claim Reviews (PDF)
- CC.Pl.10 Unbundling Adjustments on Clean Claim Reviews (PDF)
- CC.PP.014 District Procedure Mod 59
- CC.PP.031 CMS Correct Coding Initative Unbundling Edits (PDF)
- Anti-Kickback Training (PDF)
- Anti-Kickback Attestation (PDF)
- Fraud, Waste and Abuse Training: Medicaid and Medicare (PDF)
- Fraud, Waste and Abuse Referral Form (PDF)
- Model of Care Training 2022 (PDF)
- Model of Care Training Confirmation (PDF)
- Provider Model of Care Training Confirmation Submission Form
- Special Needs Plan Model of Care Training (PDF)