The deadline for provider revalidation to prevent suspension from the aforementioned medicaid programs was april 1, 2015. For your convenience, items on this qrg in bold, underlined fonts are hyperlinks to supporting wellcare of kentucky provider job aids, resource guides and forms when. Our selfservice channels are the best way to fight the coronavirus covid19. Notice of nondiscrimination wellcare health plans, inc. It is also important to know that wellcare of south carolina uses a preferred drug list pdl. Enrollment in our plans depends on contract renewal. It communicates policies and programs and outlines key information such as claim submission and reimbursement processes, authorizations, member benefits and more to make it easier for you to do business with us. Illinois medicaid provider manual 20142015 wellcare. Learn more about using your 2020 prescription drug plan. Added same day billing verbiage for behavioral health and a. As of january 1, 20, wellcare of kentucky has expanded into region 331 and avesis will administer the routine eye care benefit and eye medical benefits for those members. Provider manual january 2014 passport health plan jan 1, 2014 4. Dental services are recognized by kentucky medicaid as provider type 60 individual or 61 group. Provider manuals for fy 2020 fy 2020 provider manual for community behavioral.
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. Cabinet for timely submission of claims as received by medicaid no later than twelve 12. Part ii policies and procedures for federally jan 1, 2019 112019. Sep 26, 2014 commonwealth of kentucky ky medicaid provider billing instructions for physical therapist provider type 87 version 1. Wellcare of kentucky medicaid quick reference g november 2014 web address. For accommodations of persons with special needs at meetings, call 1877my wellcare tty 711. Generic routine and eye medical medicaid provider manual. Dbhdd publishes its expectations, requirements, and standards for community providers via policies and the respective behavioral health or developmental disabilities provider manuals. Added wellcare mco medicaid card and contact information. This provider manual is intended for medicaid providers that are contracted with wellcare and provide healthcare service s to wellcare members enrolled in a wellcare medicaid managed care plan. Page 10 kentucky medicaid pharmacy provider pos billing manual 1. Kentucky medicaid is a state and federal program authorized by title xix of the social security act to provide health care for eligible lowincome residents including children, families, pregnant women, the aged and the disabled. Resources only apply to the aged, blind or disabled population within the established guidelines.
Passport provider services at 18005780775, wellcare of kentucky at 18773899457, kentucky spirit health plan at 18666433153 and coventrycares of kentucky at 18553005528. The provider portal is packed with features to help you care for your patients our members to ensure they have a positive health care experience. Health check services epsdt all preventive or wellchild services, except normal newborn care in the hospital, must be billed under the health check program following the policies and procedures as outlined in the wellcare provider s manual. April 1, 2014 page 4 of 118 2014 florida medicaid and healthy kids provider manual table of revisions date section comments page numbers 41 2014 section 1. Passport health plan at 18005780775, wellcare of kentucky at 18773899457, humana. Provider billing instructions are displayed in adobe acrobat formats. These services may be paid for by the department on a feeforservice basis or.
You asked for a simple and efficient way to interact with us. Wellcare of kentucky partners with providers to develop and deliver highquality, costeffective health care solutions. They decide whether or not you qualify for medicaid. Finance medicare wellcare of kentucky medicaid dme fee schedule.
This will save money on vendor fees and additional costs each year. Welcome to wellcare changes to wellcare s medicaid managed care plans 810 section 1. Medicaid is a program for families and individuals who have income and resources within the established guidelines. Overview eligibility core benefits and services, and extra benefits for members. It has been designed to facilitate the processing of your claims for services provided to qualified recipients of medicaid. Wellcare partners with providers to give members highquality, lowcost health care and we know that having a healthy community starts with those who need it most. Use the find a provider tool to find providers located near you.
Purpose of this manual this provider manual is intended for missouri carecontracted participating medicaid providers. Wellcare is now part of centene creating a premier healthcare enterprise focused on governmentsponsored healthcare programs. The updates include various regulatory policy changes implemented by the department of medical services since 2016. Kentucky medicaid program routine vision and eye medical.
We understand that maintaining a healthy community starts with providing care to those who need it most. Wellcare supports local philanthropic events and are avid preventive care advocates. Nursing facility nf services include room, dietary services, nutritional supplements, social services, activities, respiratory. Commonwealth of kentucky ky medicaid provider apr 15, 2014 durable medical equipment replaced kyhealth. Jul 11, 20 wellcare of kentucky claims, authorizations and appeals all other denial code reasons accounted for just 7. The manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date. The provider manual is a resource for working with our health plan. Pharmacy services wellcare of south carolina will pay for the drugs that medicaid requires you to have. It is your responsibility to make sure that the provider accepts the kentucky medicaid card. Medicaid enrollment cabinet for health and family services. Wellcare health plans is now part of centene, which operates as fidelis care in new york state. The portal features improved member search tools, a more holistic view of member information and tools that offer more convenient. To enroll or bill kentucky medicaid, dental service providers must be.
Welcome to the kentucky cabinet for health and family services, department for medicaid services feeforservice pharmacy program portal, administered and maintained in conjunction with magellan medicaid administration. To request a free, printed copy of this manual, call provider services at. Provider type is vague but must be licensed in the state of kentucky. Wellcare has updated the kentucky medicaid provider manual, effective july 12, 2019. July 12, 2019 page 6 of 125 2019 wellcare of kentucky provider manual table of revisions date section comments page change 7122019 section1. Updates have been made to the wellcare of kentucky preferred drug list pdl. Commonwealth of kentucky provider billing instructions for. Commonwealth of kentucky ky medicaid provider billing. A health benefit plan shall not require a provider to be physically present with a patient or client unless the provider determines that it is necessary to perform those services in person. Wellcare provides certain benefits and services specified by federal requirements for health plans administering to medicaid members. You can only use your kentucky medicaid card with a participating kentucky medicaid provider. Medicare wellcare sample insurance card medicare timeline. Provider type pt the first two digits of the ky medicaid provider number.
Failure to do so will result in you being charged for the services you receive. Provider manual january 2014 passport health plan jan 1, 2014 delivering highquality, costeffective medical services to medicaid recipients in. September 30, 2014, wellcare served approximately 4 million members. Eligibility for kentucky s medicaid program is solely determined by the department.
Provider newsletter kentucky 2014 issue 1 wellcare. If there is an inconsistency between information contained in this manual and the agreement between you. Kentucky provider newsletter issue iv 2014 wellcare. Le, and the more than 69,000 providers nationwide who already partner with wellcare, please send us your information by completing our online form. Kentucky medicaid pharmacy provider pointofsale pos. Kentucky medicaid, but billing procedures and coverage of some services may differ. July 1, 2014 page 6 of 91 teamwork with our fellow associates, we can expect and are expected to demonstrate a collaborative approach in the way we work. This manual shall provide basic information concerning coverage and. Upon determination of eligibility, kentucky medicaid recipients will be enrolled with a medicaid managed care plan, provided the following conditions are met. Beginning april 1, 2014, wellcare will only accept typed original red and white cms1500 claim forms on the 0212 version. If you have any questions, please contact wellcare network relations at 18885889769, mondayfriday, 8 a. Wellcare provides managed care services focused on. Commonwealth of kentucky ky medicaid provider billing finance.
Cabinet for all providers shall be subject to rules, laws, and regulations issued by appropriate levels of timely submission of claims as received by medicaid no later than twelve 12 months from the date of. The following information will help your patients get the most out of their pharmacy benefits. Wellcare members can be confident theyre in good hands. We are excited to share that meridiancare, a wellcare company, is changing its name to wellcare, effective january 1, 2020. The meridian health plan of illinois provider manual has everything you need to know about member benefits, coverage, and guidelines. The manual was formulated to provide medicaid providers with a useful tool for interpreting the procedures and policies of the kentucky medicaid program. As a company that provides managed care services targeted to governmentsponsored health care programs, our primary. Our dsnps have contracts with state medicaid programs. Kentucky medicaid provider manual wellcare health plans kentucky medicaid plan, and for which wellcare is not financially responsible. These changes are not material and do not affect existing provider agreements. Jun 03, 2014 are similar to those of kentucky medicaid, but billing procedures and coverage of some services may differ. In 2016, edits will be derived directly from the state and national medicaid editing guidelines.
Outofstate providers must be licensed by the kentucky board of dentistry. Beginning january 6, 2014 through march 31, 2014, wellcare will allow the use of both the 0805 version and 0212 version of the cms1500 claim form when submitted on typed original red and white forms. Wellcare reports the information to contracted state andor federal agencies. Dec 07, 2014 provider manual january 2014 passport health plan jan 1, 2014 delivering highquality, costeffective medical services to medicaid recipients in the. New tollfree phone number for medicare providers starting jan. Wellcare of south carolina is committed to working with providers to improve members health and wellbeing. Wellcare of kentucky understands that maintaining a healthy community starts with providing care to those who need it most. Wellcare kentucky health insurance exchange provider manual effective. This is how much you pay when getting care from a wellcare of kentucky provider. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download. We want to work with you to provide timely, safe and effective health care to our members. Florida medicaid and healthy kids provider manual wellcare. The telehealth program is a new state program in the office of health data and analytics dedicated to assisting telehealth providers by promoting, advocating and supporting telehealth adoption across the commonwealth.
Providers with managed care plan questions should contact. Eligibility for kentuckys medicaid program is solely determined by the department. Eligibility is determined by a number of factors, including family size, income, and the federal poverty level. Provider manual at aetna better health of kentucky, we value our provider partners. Provider claims support initiative wellcare s provider network plays an important role in ensuring members receive quality health care in a timely and costeffective manner. The drugs on the pdl are organized by brand and generic name. Tips for submitting coordination of benefits claims. Providers with mco questions should contact the respective mco provider services. Providers are able to enroll as a medicaid provider either through an mco or.
Billing instructions are for fee for service ffs providers only. Cob claims can be processed more efficiently by directly submitting from. Finance medicare wellcare kentucky medicaid fee schedule. If you need to access a behavioral health provider in kentucky, you may contact any of the 14 community mental health centers cmhcs or contact the provider service hotline at 18773899457. We encourage providers to submit coordination of benefits cob claims electronically. Magellan medicaid department for medicaid services. The coverage determination process enables providers to request an addition or exception.
Aug 22, 2017 are similar to those of kentucky medicaid, but billing procedures and coverage of some services may differ. Florida medicaid and healthy kids provider manual effective. When you no longer wish to be a part of our health plan, and the steps to follow to leave wellcare of kentucky voluntary. The pdl is a list of drugs that we prefer your doctor use. Commonwealth of kentucky ky medicaid provider billing may 5, 2014 general billing instructions for paper claim forms. The web portal provides online access to prescription and kentucky specific plan information as well as supporting documentation. A provider who has received a remittance advice from the previous payer provider topayer cob. If your preferred contact information is incorrect, access your gammis account to update or submit to hp the medicaid peachcare provider information change form to prevent future mailing issues.
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