Provider : Frequently Asked Questions

Here are answers to some of the most frequently asked questions we receive from providers.  If you have a question that is not listed here, or if you need additional information, please call the Provider Hotline at 1 (800) 951-7719. 

FREQUENTLY ASKED QUESTIONS FROM PROVIDERS  

Q: I don't know my Provider ID number. Where can I find it? 
A:Your Provider ID number was included in the welcome materials you received from WellCare when you first became a participating provider. It can also be found on any Explanation of Payment (EOP) you receive from WellCare or by calling your local Provider Relations Representative. You should keep your Provider ID number where it can be easily accessed when calling WellCare. 

Q: How can I ensure I am receiving the most current eligibility information? 
A:WellCare receives downloads from the State of Ohio on the first of every month. It is important to verify eligibility via the web as close to the appointment date as possible to ensure you receive the most current information available. 

Q: How can I file my claims electronically? 
A:Filing claims electronically is the fastest and most efficient way to submit claims to WellCare. Currently, WellCare receives electronic claims from four clearinghouses: Availity, Emdeon (WebMD), SSI Group and ACS EDI Gateway. Contact us at: 1 (800) 960-2530 Ext. 4096 for details on filing claims electronically. 

Q: How can I expedite my claim? 
A:Ensuring the claims you submit include all of the necessary information can aid us greatly in processing claims quickly.  Claims that are missing information or include inaccurate information will result in delays.  It is important to use the same vendor information (i.e. name of provider/practice, Tax ID numbers) that is submitted on your W-9 form as filed with the IRS.  Simply using a slightly different version of the name of your practice can delay the processing of your claims.  Using invalid or dated CPT codes can also delay processing.

Q: What functions are available through Wellcare.com? 
A:WellCare offers secure web access to participating providers. Functions available include the ability to check member eligibility, request authorizations and check the status of submitted claims. Our provider directories and handbooks are also available online. Providers must register with their WellCare-assigned Provider ID number to gain access. Each registered provider may assign Administrative Users within their practice who will oversee all additional WellCare website users (Subusers).

To register, go to the left menu, click "Register" and follow the simple steps. Once that process is complete, you will receive your user ID and password via e-mail.