We are committed to quality service and partnership with providers to ensure members get the most of their benefits. The plan provides integrated medical and behavioral health services for members. Providerenrollmentpdf georgia department of community health. May 15, 2015 page 6 of 118 2015 wellcare south carolina provider manual georgia wellcare georgia. A third party resource is an individual, entity, or program that is. December 1, 2015, the cvo will be responsible for all recredentialing activities. For authorization and eligibility inquiries the members id number and date of birth. Wellcare of georgia is accredited by the national committee for quality assurance ncqa, a private nonprofit organization dedicated to improving healthcare quality.
Model, tnga provider portal, wellcare medicare member information, our new. The secure portal enables providers to check member eligibility, submit authorizations and claims, complete training, and more. Benefits annual eye health examination all wellcare members are eligible for one 1 annual eye health examination one. Georgia medicaid provider handbook provider services. Complete a brief profile and accept hipaa terms and conditions. Georgia provider billing communication health check services. Our selfservice channels are the best way to fight the coronavirus covid19. Providers may call the provider contact center at 770 3259600 or toll.
The provider must submit medical records for both admissions and wellcare will evaluate the records to determine if the second admission is a readmission of the first admission. Required provider training addition of providers to. Part ii policies and procedures manual for federally qualified health center services and. Providers with web navigation or georgia medicaid questions may contact the provider contact center using one of the methods below. How to quickly get in touch with wellcare to get your questions. Wellcare georgia provider manual pdf sbus6 wgpm 10 this type of wellcare georgia provider manual can be a very detailed document you will mustinclude too. This system will collect and retain all required documentation needed for dch and the cmos to make an enrollment andor credentialing determinationand allow new providers to upload. Find a provider notice of nondiscrimination wellcare health plans, inc. You will need it when registering for the secure provider portal and for managing your business with wellcare. Improve the quality and coordination of patient care. Providers may call the provider contact center at 770 3259600 or tollfree at 800 7664456.
The enclosed provider manual is your guide to working with us. Haservices provided outside of the normal periodic sequence. We understand that maintaining a healthy community starts with providing care to those who need it most. Benefits annual eye health examination all wellcare members are eligible for one 1 annual eye health examination one time every 366 days for the purpose of evaluating a members ocular health. Billing resource manual georgia department of public. One of our provider representatives will get back to you shortly about what is needed to join. Billing resource manual georgia department of public health. Vision provider manual identification card the member should present a wellcare of georgia member identification card. New providers are now able to use the ghps web portal as a single source system to complete an electronic georgia medicaid enrollment and cmo credentialing. Fqhc medicaid provider manual georgia department of.
Vision provider manual appendix b wellcare of georgia. If it is determined that the second record is not a readmission, the provider will be notified and no additional actions will occur. Billing guidelines federally qualified health center services. Led the annual provider manual and billing guide update process, which resulted in provider billing, coding and claims payment accuracy. Wellcare will identify claims that are most likely readmissions for denial or request a refund. Wellcare of georgia partners with providers to develop and deliver highquality, costeffective health care solutions. Complete the fields following the guidelines in the right navigation panel. Thank you for your participation in the easy choice health plan, a. Access materials that are available to assist new york fida providers. Web portal training georgia department of community health. As a leading provider of managed care services, wellcare is focused on. Guide to using selfservice features in the provider portal. By using our provider portal instead of calling to speak with a live agent, you are allowing our live customer service teams to prioritize services for providers who are actively assisting our most critical members during the pandemic.
Wellcare provides behavioral health benefits to members enrolled in georgia medicaid plans. Wellcare reserves the right to look back within the maximum allowed recovery time frame per state guidelines or per specific provider contract to identify any claims that may be readmissions. For claims inquiries the members id number, date of birth, date of service and dollar amount 4. An error has occurred while generating this document. Provider reports 16 rows returned georgia department of. Wellcare by outofnetwork providers for services provided from july 1, 2017 through august 14, 2017. Provider phone access guide job aids ga families and peachcare for kids. Coronavirus covid19 keep yourself informed about coronavirus covid19. Behavioral health medication reference guidegeorgia. View documents such as the provider manual, quick reference guide and newsletters.
Eligibility act notice act effective august 6, 2015, contracted hospitals and. Provider manual 2015 direct contract easy choice health plan. If you are a medicare or pdp member, please log in here. Wellcare proudly serves the georgia medicaid and peachcare for kids members enrolled in the georgia families program and women enrolled in the planning for healthy babies program. Mar 04, 2021 providers wishing to join our network for medicare only, please click the join our network link above and fill out the online form. Refer to the cmo provider manual for mailing addresses. Epservice provided as part of medicaid epsdt program. Effective october 1, 2015, all health care providers, payers. Wellcare of georgia partners with providers to develop and deliver highquality. Learn more about how were supporting members and providers. This provider handbook is intended for wellcare contracted participating medicaid providers providing health care services to.
Wellcare of georgia to launch provider email communications may 03. Information on modifier 25 and place of service coding. The georgia health information network gahin helps providers close the information gap to improve the quality of patient care across the state. Services program, located on the provider enrollment tab of the georgia mmis website, located. Provider manuals a complete copy of wellcare s provider manual is available online, including all of the necessary forms and educational materials. Medicaid preferred drug list updates effective june 1, 2011 apr 11. Access materials that are available to assist wellcare providers. Fill out the contact us form call the local number 770 3259600. What you need to know about getting started as a wellcare provider. Wellcare proudly serves the georgia medicaid and peachcare for kids.
Provider revalidation past due this report identifies provider service locations that have been notified to revalidate with georgia medicaid but have exceeded their revalidation due date. Medicare advantage provider manual provider services tollfree. Npi or tax id number for validation if you do not have your wellcare provider id number 3. If your service location is listed on the report, please submit a revalidation application through the secure gammis web portal as the service location listed. January 1, 2020 page 1 of 6 section table of contents. Providers may call the provider contact center at 770 3259600 or.
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