As previously communicated, WellCare has recently partnered with ProgenyHealth (Progeny), a company that specializes in Neonatal Care Coordination Services.
Specifically, WellCare has delegated Progeny to perform utilization management activities for infants admitted to the Neonatal Intensive Care Unit (NICU). When working with your staff, Progeny will authorize the medically necessary level of NICU care. The level of care authorized by Progeny during the members NICU stay will be checked when providers submit claims to WellCare for reimbursement. If the authorization does not exactly match the claim, the claim will be processed at the authorized level of care.
Your process for notifying WellCare of infants admitted to a NICU or special care nursery will remain the same. WellCare will notify ProgenyHealth of admissions and their Neonatal Nurse Care Managers will work in close collaboration with the WellCare team and your designated onsite staff to provide ongoing telephonic care coordination services throughout the inpatient stay.
If you have questions regarding WellCare’s relationship with ProgenyHealth or subsequent claims billing, please call your Provider Relations Representative. Thank you for your partnership in caring for WellCare members
