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Provider Resources
  • Claims Updates
    This page provides updates on WellCare's claims processes, ensuring that provider claims are handled efficiently.
     
  • Clinical Coverage Guidelines
    Clinical Coverage Guidelines (CCG) are evidence-based documents detailing the medical necessity of given procedures or technologies. The guidelines set consistent criteria for the coverage of a procedure or technology, leading to greater consistency and efficiency in clinical decision making. 
     
  • Forms & Documents
    This section is a repository of forms and documents to be used by all providers and institutions when managing care for our members.
     
  • Fraud & Abuse
    This link provides access for reporting suspected fraudulent and abusive health care practices by providers or members of the Medicaid program. You will also find resources to learn how to recognize possible fraud and abuse, and report suspicious activities. Please note that you may remain anonymous when reporting a fraudulent or abusive health care practice.
     
  • Hospital Manual
    The Hospital Manual is a resource for institutions that outlines WellCare guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide, Benefit Grids for CFC and / or ABD, and the online tools available through the secured area of our Web site.
     
  • Provider Manual
    The Provider Manual is a resource for physicians with guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide, Benefit Grids for CFC and / or ABD, and the online tools available through the secured area of our Web site.
     
  • Provider Quick Reference Guide
    The Quick Reference Guide is a resource that contains WellCare contact information and authorization guidelines. Please refer to the version on this site to ensure you are using the most current information.
     
  • Provider Education Materials
    On the Provider Education Materials page, you will find resources and guidelines ranging from Adult and Child Preventive Guidelines to Clinical Practice Guidelines. These are intended to assist both institutions and providers within our network. We encourage our providers to refer to these documents on a regular basis.
     

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