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Provider : Resources

  • Provider Manual pdf
    An extension of the Participation Agreement and a resource that provides 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 and other reference resources.

 

 

  • Provider Quick Reference Guide
    Provide WellCare of Ohio contact information and authorization guidelines.
     
  • Provider Forms and Documents
    Template forms and documents for appeals, authorizations, claims, pharmacy services and more.
     
  • Clinical Coverage Guidelines (You will be redirected to our corporate website.)
    Evidence-based guidelines detailing the medical necessity of, and sets consistent criteria for coverage of, given procedures or technologies to ensure greater consistency and efficiency in clinical decision making.
     
  • Clinical Practice Guidelines (You will be redirected to our corporate website.)
    Best-practice guidelines used to guide efforts in improving the quality of care in our membership.  CPGs are based on available clinical outcome and scientific evidence-based content developed by expert professional and clinical society recommendations.   

 

  • Fraud and 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.
     

  • Provider Training and Education Materials
    Educational resources regarding initiatives that require specific actions by providers. You must log in to access required Provider training.  Click here if you are not a registered user. 

 

  • Claims Corner
    Provides updates on WellCare's claims processes, ensuring that provider claimsare handled efficiently.
     
  • Provider Newsletters
    WellCare produces newsletters to update providers on information related to pharmaceuticals, cost and quality of care or share tips on how to perform better and more efficient business with the plan. The newsletters are also used to highlight recent successes, such as accreditations and quality scores.

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Last modified: 01/20/2012

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