Medicare
View the latest updates to Medical Clinical Policies
- Change Healthcare Cybersecurity Incident and its Impact to Wellcare
- Ascension Complete is now Wellcare Complete
- Welcome Chiropractic Providers to our Wellcare Network
- Medicare Step Therapy Part B Drug List - Effective January 1, 2024
- Durable Medical Equipment (DME) Authorizations Change On Jan. 1, 2024
- National Epic Payer Platform Announcement
- Find-a-Provider Directory Communications: Phase 1
- Important Pharmacy Claims Processing Change, Effective January 1, 2024
- New Century Health Cardiology Prior Authorization Program
- DSNP Billing for Medicaid-Covered Services
- Medicare Prior Authorization Changes Effective October 1, 2023
- Annual Special Needs Plan Model of Care (MOC) Training
- Reminder: Home Health Notice of Admission (NOA) Change
- Termination of Somatus Care Management Program for Patients with CKD/ESRD
- COVID-19 Public Health Emergency (PHE) Expiration - Effective May 11, 2023
- Medicare Prior Authorization Change Summary - Effective July 1, 2023
- Appendix A - Medicare Part B Drug List - Effective July 1, 2023
- Reminder of CMS Lab Ordering Guidelines
- D-SNP Patients Must Verify Medicaid Eligibility Annually
- New Century Health Oncology Prior Authorization List: Effective April 1, 2023
- Guidance on Effective Date for Legacy Wellcare Medicare ID Cards
- Wellcare 2023 $0 Immunizations Part D Vaccines - (PDF)
- Special Needs Plan Model of Care Self-Study Program
- Medicare Part B Drugs List: Effective January 1, 2023 (Appendix A)
- Medicare Prior Authorization Change Summary: Effective January 1, 2023
- CMS Lab Ordering Guidelines Reminder
- 2022 Medicare Radiology Center Incentive Program Announcement
- Sneak Preview of 2023 Improvements
- Medicare Provider CMS NPPES Program Update
- Peer-to-Peer Review Request Requirement Changes Effective September 1, 2022
- Care Centrix Home Health Provider Notification
- InterQual Criteria Rollout: Effective August 1, 2022
- Medicare Prior Authorization Change Summary: Effective July 1, 2022
- Medicare Billing Tips for Transplant Service Claims
- Revised Claims & Payment Policy: Leg Stent Coding Updates
- Prior Authorization Requirement Updates: Effective March 1, 2022
- Medicare Billing Updates Effective January 01, 2022
- 2022 Formulary Change Notification
- New Ophthalmology Medical Necessity Payment Policies
- Wellcare’s Provider Portal – Providers love our Live Chat!
- Point of Care Formulary Information Tools
- CPP 161: Polymerase Chain Reaction Respiratory Viral Panel Testing
- Wellcare’s Provider Portal – Now with Improved Live Chat
- New Somatus Care Management Program for patients with CKD/ESRD
- Claims and Payment Policy: Review of NOS, NEC, & Unlisted Codes
- Claims & Payment Policy: Physician Office Lab Testing: Effective
- New Portal Features: iCarePath Claim Appeals and Disputes
- New Prepay Edits: Institutional Ambulance Claims
- Prepayment Clinical Validations Edit Policy
- Appropriate Place of Service (POS) Billing
- CPP 151: Frequency of Comprehensive Ophthalmological Exams
- Short Inpatient Hospital Stay: Clinical Coverage Guideline
- CPP 145: Incorrect Billing for Severe Malnutrition Policy
- New Provider Service Number for Select Medicare Plans
- Sunshine Health and Wellcare Provider Relations Team Integration
- $0 Member Liability extended for select services until end of 2020
- New Portal Features: Edit authorizations, add attachments, and more!
- Revised ED Outpatient Facility EM Coding Policies
- Opioid Program MAT Certification
- Prior Authorization Updates: Wound Care & Skin Substitutes
- CPP 133: 340B Drug Payment Reduction Policy
- Wellcare and Sunshine Health are joining health plans
- New Medicare ID cards for 2020
- Behavioral Health Home Accreditation Subsidy Program
- Reducing Low Value Care Screenings Claims Edit Guidelines Policy
- Dialysis Claims Payment Policy
- Non-emergent Transportation Crossover Claim Submissions
- Intensity-Modulated Radiation Therapy (IMRT) Reimbursement Policy
- ED High Acuity Radiology Utilization Reimbursement Policy
- Annual Wellness Visit and Additional Annual Physical
- Inpatient Readmission Policy Update
- LabCorp Announcement
- Medicare Milliman Clinical Guidelines (MCG) Rollout
- New Urine Drug Testing Guidelines
- Prior Authorization Requirements
- Annual Wellness visit and Annual Physical Coding Refresher
- SNF Level of Care
- Dual SNP Cost-Sharing Update
- New Modifier Claims Edit Guideline (CEG)
- Prior Authorization Requirements
- HealthHelp
- New Medicare Cards
- Exciting Authorization Rule Enhancements
- Your Partner in Medicare Quality Care
- Providers Filing Appeals on Enrollees' Behalf
- Centauri Medical Record Collection
- Pharmacy Benefit Manager
- Inpatient Readmissions Policy
- American Therapy Network contract termination
- Coding Reminder: Modifier 25
