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DSNP Billing for Medicaid-Covered Services

September 8, 2023

As a valued provider for Wellcare DSNP members (Medicare/Medicaid eligible), Wellcare and Sunshine Health are dedicated to ensuring your claims and prior authorization requests are processed timely and accurately.

To ensure your claim is routed appropriately for DSNP members, begin by verifying member eligibility in the FLMMIS, Florida Medicaid Managed Information System. If you see "Sunshine State Health Plan" listed as the Medicare primary, that means a member has Wellcare Medicare. Claims and prior authorization requests for Medicare/Medicaid covered services should be routed to Wellcare Medicare.

When the Medicare benefit has exhausted, the claim will automatically process through Sunshine Health for Medicaid-covered services.

Download the Wellcare Quick Reference Guide for details on claims submissions and prior authorizations.

If you have questions about this notice, please contact your Provider Engagement Administrator or call Wellcare Provider Services at 1-855-538-0454. Stay up to date on Wellcare provider notices by reviewing and bookmarking Bulletins.

 

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Last Updated On: 9/8/2023
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