We recognize that, at times, the administrative requirements of managing your patients' health care can be complex. The Provider Manual is a source to use for questions about health plan coverage procedures, policies and other facts related to your provision of health care services to our members.

Claims

  CMS 1500 Submission Guidelines for Paper Claims
  CMS 1500 Submission Sample
  UB-04 Submission Guidelines for Paper Claims
  UB-04 Submission Sample

  Change of Provider Information Form
  Outpatient Treatment Plan Update Form
  Pharmacy Drug Evaluation Review Form
  Sample Authorization Letter
  WellCare Incident Report Form
  W-9 Request for Tax Identification Number

Provider Manual

  Welcome Letter
  Table of Contents
  Section 1 - Health Plan Overview
  Section 2 - Member Services
  Section 3 - Provider Responsibilities
  Section 4 - Clinical Services and Administration
  Section 5 - Utilization Management
  Section 6 - Claims Processing
  Section 7 - Pharmacy Services
  Section 8 - Records Management
  Section 9 - Grievances & Appeals
  Section 10 - Credentialing
  Section 11 - Evidence Based Guidelines
  Section 12 - InterQual^® Criteria Reference Guide
  Section 13 - Quick Reference Guide