How can I tell if a member is enrolled in a special program?

Special Programs are also known as CM/DM. Members who are enrolled in special programs will have extra information on their member details page that identifies the program(s) they are enrolled in.

How do I submit a medical authorization?

To check whether an authorization is needed, complete the minimum amount of information needed for validation and submit: Member ID – select the member first and the member information is pre-populated into the authorization form; Provider ID – the requesting provider information is pre-populated into the form based on their login information; Place of Service; Number of Visits and CPT code(s). An authorization can be submitted up to 30 days prior to the service date. Note: If you are submitting an authorization for one of the following, you will be directed to their website to complete the authorization: eviCore, eviti, CMPCN and Georgia State website.

How can I manage User Accounts?

Access requests are located on the My Practice page. You must have administrator authority to grant users access and permissions for your location.

I forgot my Password, what can I do?

Users are able to reset and then change password by providing their Username, Answer to security questions, and Email address associated with registered account.

If you encounter an error while resetting your password, please contact customer service. You can find the customer service number by selecting State and Plan in the Help section.

What types of communication is available in the secure messaging inbox?

Your secure messaging inbox is designed for communicating with colleagues as well as sending and receiving messages from WellCare. You can perform these actions from your inbox: Receive and reply to messages, View and open messages, Create and send messages and Download and print attachments from message.

Where can I view reports?

Reports are located in the Reports Center under the My Practice heading. You can view these reports: Active Members, Inpatient (Hospital) Log, Care Gaps, Members Overdue for Screening (EPSDT), Member EPSDT Visit History and Members Admitted/Registered as Inpatient.

How do I appeal a denied authorization?

To appeal an authorization in Denied status, search for the authorization using one of these criteria: Member/Subscriber ID, Provider ID, Patient Name and Date of Birth, Medicare ID or Medicaid ID. Search results will display based on date of service. Select Authorization Appeal from the drop down. Fields will be pre-populated from the original authorization request. Attach supporting documentation as necessary. Note:  For the Medicaid lines of business, an appeal cannot be submitted unless the member consent checkbox is selected.

What is Disclosure of Ownership?

The Disclosure of Ownership form is provided by the State. To access and complete the Disclosure of Ownership form, navigate to the My Practice tab. You can select a form to complete and also submit it from the portal.

How do I view referral submission history?

To view referral submission history, select the Referrals tab on the Care Management page. Search Referrals using one of the following search criteria and then choose a date range: Member ID, Member Name and Date of Birth, Requesting Provider ID or Treating Provider ID.

Can I update my my Account Information?

You can edit your account information including: First Name, Last Name, Email Address, Phone Number and add a new Email address from My Preferences. My Preferences is available under your name at the top of the Web page.

How can I update provider demographic information?

Demographic information can only be managed by an account Administrator. Information that can be updated includes areas that fall under the Contract (IPA) level, Location details and the Roster level.

Where can I find information about member emergency room visits?

The Visit History tab displays the last five emergency room visits of the member whose details you are viewing. Locate Visit History information from the member details page. Your member roster is located on the My Patients page. Find a member by searching or sorting and filtering. Once you find the member, select View Details from the Select Action drop down.

Can I create a visit checklist to facilitate member care?

The Visit Checklist is a great tool to use when meeting with WellCare members. It contains important information about topics like Care Gaps, emergency room visits and medicines they may or may not be taking. You can view and print the checklist as well as update it and submit it after you’ve met with the WellCare member.

How can I download training for my records?

After attesting to training, you may access and download the completed training transcript for your own records.

How do I know if WellCare has been unable to contact a member?

If WellCare has been unable to contact a member, an exclamation point icon will be viewable in the Important Information area on the member roster. When you select a member and view their details the Select Action drop down, the system will display an Unable to Contact (UTC) indicator that information needs to be updated. When you update the member information, the Unable to Contact indicator will disappear.

Can I request voluntary contract termination from the portal?

The Voluntary Termination form is located on the My Practice tab. 

How can I view and request Provider Roster changes?

IPA/Provider Group administrators will have the ability to add and remove providers from the roster.

Where do I view Pharmacy Utilization?

Locate the Pharmacy Utilization tab on the member details page. If the member is taking medication, it will be listed here. Complete pharmacy information is located on the details page of the Pharmacy Utilization tab.

How can I access my training?

Access Training from the Resources tab.  A list of available trainings will display. You can also search for training.

How do I search for a specific member?

Search for a member from the My Patients page. You can search for one or multiple members using either Member ID, Patient Name and Date of Birth (DOB) or Provider ID. Additional search criteria for Member ID are Medicaid ID and Medicare ID.

Where do I find the Request to Transfer Member form?

Locate the Request Member Transfer form in the Select Action drop down of the member you want to transfer. Search for the member or locate the member in the member roster. The Request Member Transfer form will display with pre-populated information about the member.

Can i view full claim details?

Begin by searching for a claim or multiple claims on the Search Claims webpage. To view full claim details, click on the Select Action drop down then select View Details.

How do I dispute a claim?

You can dispute a claim with a status of fullypaid. Use the claims search option to find the claim. From the Select Action drop down, choose Dispute Claim. A form will open with the fields pre-populated from the original claim. Choose the paid line items you want to dispute. When you submit the dispute, the system will validate the fields for errors prior to submission.

Where do I check member eligibility and benefits?

Check member eligibility and benefits from your My Patients page. Search for one or several members and view their details from the Select Action menu.

How do I submit a professional claim?

Electronic claims submissions provide real-time status updates, allow you to include authorizations and attach additional documentation as necessary as well as pre-populating member and provider information. To begin a Professional Claim Submission select a member and the member information will be pre-populated or manually enter the information in a blank form. Complete the required fields. Attach up to a maximum of 10 documents. The system will perform field level validation when you submit the claim.

How do I check claim status?

View claim status at any phase during the process, including Denied with denial reason.  To check claims status, begin by searching for one or multiple claims. You can lookup claims using either the WellCare Control Number (WCN), Claim Number, Medicaid ID, Medicare ID, Member ID or Member Name and Date of Birth.

How do I correct a claim?

Correct a claim by performing a search for one or multiple claims. To correct the claim click on the Select Action drop down then select Correct Claim. Fields from the original claim are pre-populated and editable except for the member and provider IDs.

Where do I view authorization and referral history?

View Authorization and Referral history from the My Patients page. Search for a member or choose a member from the member roster and then select View Details from the Select Action dropdown.

Can I save a draft of my claim?

You can save a partially completed claim and retrieve it for later use. The draft claim must contain a provider ID, member ID, one manually-entered field. The system will validate that these fields are populated and save the draft. Claims drafts are saved until you retrieve them for further action.

After taking training, what do I need to do?

You can attest to training at any time. Locate the training module and from the Select Action dropdown, select Attest Training.

What is an account administrator?

Administrator roles have the sole responsibility of creating and managing the accounts and users within. Limited to one “admin” per Provider (IPA), the admin role has access to information regarding the accounts that other role types cannot.

How do I void a claim?

Claims with a status of fullypaid, fullydenied or rejected can be voided. The original claim data will be not be editable. You may choose to Void the claim or cancel out of the claim.

Where can I view claim history for a member?

View member claim history on the Patient Billing tab located on the Member Details page. From the My Patients page, search for either a  member or select a member from the member roster then select View Details from the Select Action dropdown.

How do I know if a member has Care Gaps?

Care Gaps and other important information is denoted with an exclamation point icon on the My Patients page member roster. Search for, or select, the member whose details you want to view and then select View Details from the Select Action drop down to get specific information about member Care Gaps.

What types of Authorizations can I submit in the portal?

You can submit two types of authorizations in the portal - Inpatient and Outpatient. The Inpatient Authorization is used for services such as planned elective/non-urgent inpatient, observation, and skilled nursing facility and inpatient rehabilitation authorizations. The Outpatient Authorization Request is used for services such as follow-up consultations, consultations with treatment, diagnostic testing, office procedures, ambulatory surgery, radiation therapy, out-of-network services

How do I send a secure message?

You can send two types of secure messages: Interoffice and WellCare. Interoffice – messages that are sent to colleagues within your office. When you select Interoffice from the dropdown, a list of users associated with your office will display. WellCare messages are sent to specific areas at WellCare. You are required to select a topic when sending a message to WellCare so that it is routed to the right person. Currently, WellCare messaging is not available, but will be at a later time.

Can I download, save and print reports?

Select the report you want to run from the Reports tab on the My Practice page. Search for the report by Provider ID and then choose the report you want to save and print.

How do I check the status of a medical authorization?

Check authorization status by performing a search using one of these criteria and selecting a date range: Member/Subscriber ID, Provider ID, Patient Name and Date of Birth, Medicare ID or Medicaid ID. From the results, you can view the details, appeal the authorization as well as download and print the information.

How do i submit a referral?

You can submit two types of Referrals: Consult Evaluation Only and Consult and Treat. These fields are required to submit a referral: Requesting Provider ID, Referral Type (Consult Evaluation Only; Consult and Treat), Member ID, Primary Diagnosis Code (at least 1 needs to be entered), Treating Provider ID, Issued Date, Expiration Date and Reason for Referral.

How do I request affiliation to a provider?

Upon registering an account,you will receieve an email to select wheter you want to request access by contract or location. 

How do I create a portal account?

Create an account by filling out the requisite fields and selecting security questions and answers. You must agree to WellCare's HIPAA terms and conditions to proceed.

How do I appeal a claim?

To appeal a denied claim use Search Claims search for a claim that has been denied. Once you locate the claim, click on the Select Action drop down then select Appeal Claim and fill in the fields. Attach documents that support your appeal request. If you need a response within 72 hours click the checkbox marked Expedited/Urgent.

I can't remember my Username, what can I do?

You can retrieve your username by providing some combination of your Name (First and Last) and the correct response to the security question that was selected when your account was created as well as the Email address associated with registered account.

What are the different roles and permissions associated with my account?

When you create an account, you will be assigned a role with permissions by the administrator for your location. Your role is based on the access level you need to do your work. If your location does not have an administrator, contact WellCare Customer Service for assistance.

How do I search for claims?

You can search for claims using different criteria: Claim number - enter one or multiple claim numbers, separated by commas, to search for claims; Medicaid ID:  Enter one or multiple Medicaid IDs, separated by commas, to search for claims; Medicare ID: Enter one or multiple Medicare IDs, separated by commas, to search for claims; Member ID: Enter one or multiple Member IDs, separated by commas, to search for claims; Member Name and Date of Birth - when searching for a specific member, enter their name and date of birth; Provider ID: Enter one or multiple Provider IDs separated by commas, to search for claims; Member ID: Enter one or multiple Member IDs, separated by commas, to search for claims or WCN Number (WCN): Enter one or multiple WCN numbers, separated by commas, to search for claims.

When do I submit a professional claim versus institutional claim?

Professional billing is responsible for the billing of claims generated for work performed by physicians, suppliers and other non-institutional providers for both outpatient and inpatient services. Institutional billing is responsible for the billing of claims generated for work performed by hospitals, skilled nursing facilities and other institutions for outpatient and inpatient services including the use of equipment and supplies, laboratory services, radiology services and other charges.

How do I submit an institutional claim?

Electronic claims submissions provide real-time status updates, allow you to include authorizations and attach additional documentation as necessary as well as pre-populating member and provider information. To begin an Institutional Claim Submission select a member and the member information will be pre-populated or manually enter the information in a blank form. Complete the required fields. Attach up to a maximum of 10 documents. The system will perform field level validation when you submit the claim. For your convenience, the electronic version of the Institutional Claim was designed to have the same look as the paper claim form.

What is the difference between Medical Authorization and Drug Authorization?

A Medical Authorization is based on based on a medical need such as inpatient rehabilitation. You can submit two types of authorizations in the portal:  InPatient and OutPatient. Once you complete each authorization request, you can download or print a summary report for your records. A Drug Authorization is a request for prescription drug coverage. Drug authorizations are currently not available but will be at a later time.

How do I reply to a secure message?

If you choose to reply to a message, you may also include hyperlinks and attach documents to your response.

What portal access do non-participating providers have?

Non-Par providers will have limited access to the Portal, which includes the ability to Search and Submit Members, Claims, Authorization, Care Gaps and more. This feature is currently not available, but will be at a later time.

What are the different areas in the portal?

The WellCare provider portal has been structured for ease of navigation. Access to the different sections in the portal is based on your roles and permissions. The areas of the portal are: My Patients - check member eligibility and benefits, lookup members, find member details, create visit checklists; Care Management - run the care gaps report, find authorizations and referrals, create authorizations and referrals; Claims - lookup claims status, create institutional and professional claims; My Practice - run reports, manage uses (admin role); Resources - take training, attest to training, view training. transcript.

Where can I update my security questions?

The Update Security Questions function is located on the My Preferences page. Access My Preferences by selecting the dropdown that appears under your name at the top of the webpage.

What can I access?

You will be able to access the areas of the portal in which you do your work. If your role changes or you need additional access to areas of the portal, contact your administrator. 

If you do not have an administrator assigned to your account, contact WellCare Customer Service.

Can Customer Support Access My Computer to Help Me?

Customer Service can access your computer by using a cobrowsing session.  Cobrowsing is initiated when you press ctrl+enter.  A window will appear with a cobrowsing code. Share the code with the customer support representative and they will see your display. They can help you through an issue you are having and they can also request to control your display and show you how to solve your issue.

Where can I change my password?

The Change Password function is located on the My Preferences page. Access My Preferences by selecting the dropdown that appears under your name at the top of the webpage.