- Welcome to Wellcare!
- Non-Wellcare Provider Resources
- Medicare Providers
- Clinical Guidelines
-
Medicare Provider Bulletins
- Medicare Bulletin Archive
- 23-1153 Get Ready! D-SNP Plans are Undergoing Major Changes in 2024
- 24-656m Be Ready for the 2024 Provider Appointment Availability, After-Hours and Phone Surveys
- 25-257: Learn How to Create a Positive Outcome, Improve Access to Care and Build an Effective Care Team
- 2025 Medicare Mammogram Facility Incentive Program
- Important 2025 Medicare Plan Changes
- ADT Reports Change From Excel to CSV Format Effective June 6, 2025
- Refer Members to In-Network Providers to Minimize Out-of-Pocket Costs
- 24-1130m 2025 Non-formulary Drug Alternatives Flyer is Available for Physicians and Other Providers
- Resources to Help You Easily Navigate the Availity Essentials Provider Portal
- Find Out What Changed: New Coverage Requirements for PrEP
- 25-195m: Stay Compliant By Reviewing Changes to Medical Policies for Medicare
- Claims & Payment Policy (#133): 340B Drug Payment Reduction Policy
- 24-107m: Find Out What Changed: AB 1369 Expands Access to Care for Eligible Patients via Telehealth
- 24-501m Support Nurse Practitioners and Physician Assistants in Expanding Access to Care
- 25-221: You Can Now Find Provider Training and Other Resources on Our Website in One Spot
- 23-985m: Refer Members to Access2Care™ for No-Cost, Routine Transportation Services
- 24-243m: Improve Patient Satisfaction with Advanced Access
- 23-1213m Annual Medical Records Collection Begins January 1, 2024
- 24-1210m: Annual Medical Records Collection Begins January 2, 2025
- Annual Wellness Visit and Additional Annual Physical Coding Refresher
- 23-479 Asthma Medication Ratio (AMR)
- Exciting Authorization Rule Enhancements
- Have You Registered for an Availity Essentials™ Account?
- 24-260 Availity to Host Live Training Webinars for Providers
- 22-667 Submit Claims-Related Attachments via the Availity® Portal
- Streamline Your Provider Portal Operations with Availity Essentials™
- 23-645m Prioritize Bicillin® L-A to Treat Syphilis in Pregnant Persons Until Q4 2023
- 23-129: Blood Pressure Control for Patients With Diabetes
- 22-968: Breast Cancer Screening Tip Sheet
- 23-020: Members with Alcohol or Substance Use Disorder Can Be Referred to Bright Heart Health
- 23-156: CAIR Registry Immunization Reporting
- California State of Emergency
- 23-641m Know What You Are Responsible for to Coordinate Care for Your D-SNP Patients
- 24-959m Improve Members’ Experience with Care Coordination
- Important update to the clinical coverage guideline for Post-Acute Care
- Join the CDC National Forum on COVID-19 Vaccine
- CDPH COVID-19 Vaccine Outreach to Black and African American Communities
- CDPH Directs Health Care Providers to Pause Administration of Johnson & Johnson COVID-19 Vaccine
- 24-246: Change Healthcare Cybersecurity Incident and its Impact to Wellcare
- 23-912 Join Us for a Webinar on CMS Risk Adjustment Model Changes
- 22-287: Early treatment can lead to a 90% survival rate after five years
- 22-104 Controlling Blood Pressure
- 22-813: Avoid Payment Delays With Correct Claims Coding
- County Partner to Expand Access to COVID-19 Vaccines
- Updates to COVID-19 Vaccine Eligibility Requirements
- Fraud Alert about COVID-19
- 22-431 Offer Patients Added Treatment Options for COVID-19 with Oral Antivirals
- COVID-19 Vaccine(s) Information and Health Plan Updates Training
- COVID-19 Vaccines: What You Need to Know
- 23-1481 Data Sharing Agreement
- 23-032 Reminder to Sign Data Sharing Agreement to Exchange Patient PHI
- Dialysis Claim Payment Policy
- 24-279 The DMHC Encourages Flexibility After Cyberattack on Change Healthcare
- 22-852: What You Need to Know for Your Dual Eligible Patients
- 22-798 D-SNP “Look Alike” Members Are Transitioning!
- 22-436 Heads Up! Be Aware of Changes for Your D-SNP “Look Alike” Patients
- 23-1058: DSNP Plans are Changing, Effective January 1, 2024
- 23-1149 Important Changes to D-SNP Plans in 2024
- 23-1151 Don't forget: D-SNP Plans are changing in 2024
- 23-002: The D-SNP “Look Alike” Transition to D-SNP is Now Complete
- 23-102: D-SNP Transition Process Survey
- 22-711 Prepare For Your Dual Eligible Patient Transition to a D-SNP and Exclusive Aligned Enrollment Plan
- 22-804: It’s Almost Here - Dual Eligible Special Needs Plan (D-SNP)!
- 22-811 PCP Prevent Elderly Suicide Webinar
- Emergency Department (ED) High Acuity Radiology Utilization Reimbursement Policy
- 22-033 Encourage Patients to Continue to Protect their Health During the COVID-19 Crisis
- 23-064: Enhancing Patient Care Through Risk Adjustment
- 23-840m: Easily Exchange Clinical Information with Epic Payer Platform
- Epocrates Point of Care Formulary Information for Providers
- 23-1185 Change from CVS to Express Scripts
- 24-629m: Extended-Days Supply Prescription
- Submission Timelines Extended from 60 to 65 Days for Certain Appeals
- 23-124: Eye Exam for Patients With Diabetes
- Your Role in Following the False Claims Act
- 24-276m Medical Policies – February 2024
- 24-965m: Want Healthy Patients? Recommend the Flu Vaccine
- 22-883 Keep Patients Healthy with Flu Vaccine Recommendations
- 24-007m Keep Patients Healthy with Flu Vaccine Recommendations
- 23-806 Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC)
- Delegated IPAs Must Ensure Staff Takes Required Transgender, Gender Diverse or Intersex Training
- 23-663m Get Paid Faster with Payspan®
- 24-635m: Tip Guide Helps Improve Patient's Health and Health Outcomes Survey Measures
- 22-253 Healthcare Ready Provider Webinars
- 22-864m: HEDIS® Annual Medical Records Collection Begins December 1, 2022
- 21-829: Learn How to Improve Your HEDIS® Rate for Breast Cancer Screening
- 22-164: Learn How to Improve Your HEDIS® Rate for Osteoporosis Management
- 22-651: Learn How to Improve Your HEDIS® Rate for Osteoporosis Screening
- 23-421 Learn How to Improve Your HEDIS Rate for Osteoporosis Screening
- HEDIS Supplemental Data Submission Deadlines for Measurement Year 2024
- Submit HEDIS® Supplemental Data By August 1, 2024
- 23-1062: Introducing the New One-Stop for All HEDIS® Tip Sheets
- 22-374: Learn How to Improve Your HEDIS® Rate for Transitions of Care Measure
- 23-134: Hemoglobin A1c Control for Patients With Diabetes
- 23-1410 Prepare for the Opioid Care Honor Roll and Next Year’s New Sepsis Care Honor Roll
- 22-082 Identify, Accept and Treat Your Wellcare Patients
- 22-593: Strengthen Cultural Humility and Dismantle Implicit Bias in Healthcare/Social Services
- 23-205m Updated Guide to Improve Health Outcomes
- 23-588: Learn How to Improve Your HEDIS Rate for Osteoporosis Management
- 22-050 Improve Patient Experience and Quality of Care
- 22-374 Learn How to Improve Your HEDIS Rates for Transitions of Care Measure
- Inpatient Readmissions Policy
- Intensity-Modulated Radiation Therapy (IMRT) Reimbursement Policy
- 22-976: Sign Attestation by January 31, 2023 to Exchange Patient Health Information
- Access Interpretation Services 24/7 at No Cost
- Join Our Webinars Which Energize and Sustain the Health Care Workforce
- 23-139: Kidney Health Evaluation for Patients With Diabetes
- Los Angeles County Large Scale Vaccination Events – Phase 1A and Phase 1B Tier 1
- 22-801: Learn More About D-SNP to Help Support Your Patients
- 22-857: Build an LGBTQ+ Allied and Experienced Practice
- 23-246m: Find Local Resources Your Patients Need
- 24-783m: 2024 Medicare Mammogram Facility Incentive Program
- 24-803: Medical Medication PA Updates
- 24-185 View the New Web Page for Medicare Medical Policies
- Coding Reminders
- 22-845: Medicare HOS: Management of Fall Risk and Urinary Incontinence
- 24-1258m: Review Changes to Medicare Medical Policies - November 2024
- 24-934m: Stay Compliant By Reviewing the Changes to Medical Policies for Medicare
- Medicare Milliman Clinical Guidelines (MCG) Rollout
- 24-549: Medicare Prior Authorization Update for CPT PLA and Cat III Codes Effective July 1, 2024
- Medicare Prior Authorization Change Summary: Effective October 1, 2023
- Your Partner in Medicare Quality Care
- 23-345m: Help Your Patients Stay on Their Medication Therapy Plan
- 24-1015m: Medication Formulary Changes – 4th Quarter 2024
- 25-027m Medication Formulary Changes – 1st Qtr 2025
- Assist Members With Getting Care Fast
- 23-631: Member Rights and Responsibilities
- 23-385m: Recognize and Address Mental Health Symptoms Early
- 22-355m Recognize and Address Mental Health Symptoms Early
- State of Emergency: Mountain Fire in Ventura County
- 22-874: What to Know About the MPX Virus
- 23-341: Naloxone: Saving Lives by Reversing Opioid Overdose
- 24-892: Expand Your Patients’ Behavioral Health Options With LMFTs and LPCCs
- New Coding Integrity Reimbursement Guidelines
- New Modifier Claims Edit Guideline CEG
- New Urine Drug Testing Guidelines
- 23-798 No-cost Interpreter Services
- Use Updated Template to Notify Members of Specialist Terminations
- DOH offers resources for diagnosis/treatment of 2019-nCoV (Novel Coronavirus)
- 22-574m: Online Tip Sheets
- 24-944m: How to Make Sure Your Claims Aren’t Rejected
- 24-545: Prior Authorization Extensions for All Services, Including DME, Ends June 30, 2024
- 22-773 Get Paid Faster with Payspan
- 22-297 Get Paid Faster with Playspan Webinar
- PBM Change Notification
- 24-342 Follow These Guidelines When Requesting a Peer-to-Peer Review With a Medical Director to Discuss An Adverse Determination
- 22-596: Prepare for Changes to Peer-to-Peer Review Requirements
- 24-1350: Performant Recovery Begins DME Claim Audits February 1, 2025
- Physicians Can Now Supervise Up to Eight Physician Assistants When Criteria Are Met
- Plan All-Cause Readmissions (PCR)
- Preventing Suicide Among Healthcare Professionals and Staff
- 23-539m Bill Preventive Colonoscopies with Correct Modifiers for No Cost Share Benefits
- 23-347: Bill Correctly to Get Paid for Primary Diagnosis and Interim Claims Submitted
- 23-456: Know What Changes are Coming for Prior Authorization
- 24-477m Medicare Prior Authorization Changes for Part B Medications
- Prior Authorization Requirements
- 22-815m Get Ready for the 2023 Provider Appointment Availability, After-Hours and Phone Surveys
- 24-157 Provider Communications and Operations Manual Updates for January 2024
- 22-681: Provider FMC Tip Sheet
- Provider IVR Claims Menu Redesign
- 22-348a Provider Resilience Sessions
- 22-562m: 2022 Provider Satisfaction Survey
- 24-475: Follow CMS Requirements for the Plan and IPAs to Notify Members of Provider Terminations
- 23-838: Save the Date: Annual Provider Satisfaction Survey
- 23-907: Join Us for a Webinar on 2023 Medi-Cal Risk Adjustment Model Changes
- Readmission Policy Update
- 22-842m: Reduce Overdoses and Save Lives With These Programs and Resources
- Reducing Low Value Care Screenings Claims Edit Guidelines Policy
- 23-1165: Register Today: The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey
- 23-339m: Reminder: Screen Members Annually for Depression
- 24-351: New Laws Help Safeguard Privacy and Enhance Protections for Reproductive Rights
- 3/1/2019: Revised Emergency Department (ED) Outpatient Facility Evaluation and Management (E/M) Coding Policies (Effective 10/1/2019)
- 24-282m Join Us for a Webinar on 2024 Medicare Risk Adjustment Model Changes
- 24-826: Let Us Know If You Offer Same-day Scheduling!
- 24-675m: Save the Date Summer 2024
- 24-1310m: Find Out What’s Changing for Partial Dual Eligible Medi-Cal Members in 2025
- 24-339m Complete the Special Needs Plan Model of Care Training
- State of Emergency: Bird Flu in California
- 24-1021: State of Emergency Bridge and Airport Fires
- 22-796 State of Emergency Due to Fairview Fire in Riverside County
- 22-1037: State of Emergency Due to Ongoing Effects of Route Fire in Los Angeles County
- 23-988: State of Emergency: Impacts from Tropical Storm for Multiple Counties
- 23-1015: Update to State of Emergency: Impacts from Tropical Storm for Multiple Counties
- 23-606: State of Emergency in Ventura County Due to Ongoing Winter Storm Impacts
- 24-126: State of Emergency Due to Intense Rainfall in San Diego and Ventura Counties
- State of Emergency in LA County Due to Interstate 10 Fire
- 24-975: State of Emergency: Land Movement in the City of Rancho Palos Verdes
- 24-986: State of Emergency: San Bernardino Fire
- 24-685: State of Emergency: Winter Storm Recovery Effort
- 24-182: State of Emergency: Winter Storms in 13 Counties
- 23-298 SOE: Severe Winter Storms Impacting 9 More Counties
- 24-304: Update to State of Emergency: Winter Storms to Include 11 Additional Counties
- 23-252: State of Emergency: Severe Winter Storms Impacting Multiple Counties
- Statewide State of Emergency Due to Winter Storms
- New Somatus Care Management Program for patients with CKD/ESRD
- 22-182 Expect communications from Somatus, Inc., a specialty kidney care vendor
- State of Emergency: Southern California Windstorm and Fires
- 23-301: Statin Therapy for Patients with Cardiovascular Disease
- 22-010 Statin Therapy for Patients with Cardiovascular Disease
- Go Online to View Updated Drug List Requiring Medicare Part B Step Therapy
- 22-780 Strengthen Cultural Humility and Dismantle Implicit Bias in Maternal Health
- 22-953: Submit Attestations Online for Chronically Ill Members
- 24-1050m: No-Cost Accredited Provider Training to Enhance Your Skills in Suicide Prevention
- 23-469: Suicide Safer Care Webinar
- 24-744: Summer 2024 Provider Pulse Newsletter
- 22-688m Help Your Patients with Diabetes Adhere to Statin Therapy Treatment
- 24-255m Use These Vendors for Supplemental Benefits
- 24-1238b: 2025 Medicare Supplemental Vendor Contact Information
- 22-022 Support for Wellcare Members Impacted by Storms
- 23-491: Support Patient Care and Get Paid on Time; Adhere to Reporting and Prior Authorization Processes
- 22-999: Tenet Health remains in the Wellcare network
- 22-171m Improve Your Patients’ Experience with Timely Access
- 23-1221m Transitions of Care Management (TRC) Worksheet Now Available Online
- 23-1193m Upcoming Change: Wellcare Offers an Easier Way to Access Utility Assistance and More in 2024
- 25-269m: Updates to Medicare Clinical and Medical Policies – April 2025
- 22-859m: Update and Certify Provider Data in CMS’s National Plan & Provider Enumeration System (NPPES)
- 23-305m: Updates Made to SPC HEDIS® Tip Sheets
- 23-430m: Use Correct CPT Codes and HCPCS Billing for Medicare
- 23-1012 Go Online to View Prior Authorization Changes
- 23-179m: Watch New Online Training About Clinical Care Metrics and Patient Experience
- 22-834: Los Angeles County: What to Know About the Monkeypox (MPX) Virus
- When Can Your Patients Get Their COVID-19 Vaccine?
- 22-731 Prior Authorization Required for Wound Care Visits Over 12
- Monthly Update Archive
- 24-210: February 2024
- 24-309: March 2024
- 24-452: April 2024
- 24-573: May 2024
- 24-686: June 2024
- 24-870: July 2024
- 24-926: August 2024
- 24-1054: September 2024
- 24-1183: October 2024
- 24-1254: November 2024
- 25-029: December 2024
- 25-118: January 2025
- 25-214: February 2025
- 25-311: March 2025
- 24-115m: Stay Informed With the Winter 2024 Wellcare Provider Pulse Newsletter
- 24-246: Change Healthcare Cybersecurity Incident and its Impact to Wellcare
- Medicare Provider Newsletters
- ICD-10 Compliance
Need help? We're here for you.
Contact Us
Last Updated On: 4/18/2024