April 28, 2025
New updates help support you and the members you care for, providing more flexible terms for prior authorizations, claims submission and more
Wellcare is applying flexible timeframes for the processes and services described in this update for physicians and other providers in Los Angeles and Ventura counties displaced by recent wildfires. These changes are in response to All Plan Letter (APL) 25-005 released by the Department of Managed Health (DMHC) on March 19, 2025, which applies to Commercial and Medi-Cal plans only. This APL was issued following the Governor’s State of Emergency in Los Angeles and Ventura counties on January 7, 2025, due to wildfires. The Plan is applying the flexible time frames and services described below to all impacted network providers, including Medicare providers servicing Wellcare members.
Flexible terms for displaced providers
The timeline extensions below apply to physicians and other providers displaced by the wildfires in Los Angeles and Ventura counties. Independent practice associations (IPAs) processing prior authorizations or claims on behalf of the Plan must comply with the following timeline extensions:
- Existing prior authorizations submitted between January 7, 2025, through March 19, 2025, will be extended by 180 calendar days from the standard 90 days.
- Timeline extension for claims submission – the timeframe for contracted and non-contracted providers to submit claims will be extended to 365 days from the date of service beginning January 7, 2025, until the State of Emergency is declared over under California Code of Regulations, title 28, section 1300.71(b).
- Timeline extension for overpayment disputes – if you have been notified by the Plan of an overpayment between January 7, 2025, through March 19, 2025, the minimum time to dispute the overpayment will be extended from 30 working days to 180 calendar days.
Temporary delivery of care in alternate settings
As of March 19, 2025, displaced physicians and other providers may deliver care from appropriate alternative settings, such as mobile clinics or temporary locations, for six months.
Benefits during a disaster web page
The Plan has created a public-facing resource web page for providers to easily access information about benefits available during a disaster. Physicians and other providers do not need to log in to the secure provider portal to access this page.
To view the page, go to https://bit.ly/wellcare-providers > Assistance for all Providers impacted by Southern California Wildfires.
Additional information
For more information on APL 25-005, visit https://bit.ly/APL-25-005. If you have questions regarding the information contained in this update, contact 1-866-999-3945.
This information applies to Physicians, Independent Practice Associations (IPAs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
