WellCare has more than 20 years of experience in health care, with a majority of that time focused on government health programs. WellCare Private Fee-for-Service (PFFS) plans are an easy option for doctors who have Medicare patients, with these advantages: - PFFS plans are not HMOs or PPOs.
- Referrals or preauthorizations of health care services are not required.
- No contract is required between WellCare PFFS and the provider. (CMS approved service area.)
- Provider reimbursement is based on published Original Medicare rates, reimbursement guidelines and methodologies, less the member's cost-sharing amounts. Medicare Local Medical Review Policies apply.
- Wellcare PFFS directly reimburse physicians and other health care professionals for non-dual-eligible members. Reimbursement for dual-eligible members will be paid first by Medicare through WellCare PFFS. The difference will be paid by Medicaid, up to the state payment limit. (CMS approved service area.)
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Provider Service Center
1-866-235-2770
(TTY/TDD: 1-866-239-6265) Monday–Sunday, 7am to 2am Eastern
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| Some of our plans include dental, hearing, vision and fitness benefits, and Part D coverage. So when you start seeing WellCare PFFS member identification cards, remember-they're a healthy step forward for your patients and your practice. For Provider Service Center, contact 1-866-235-2770 (TTY/TDD: 1-866-239-6265) Monday–Sunday, 7am to 2am Eastern. What is a Private Fee-for-Service (PFFS) Plan?
A Medicare Advantage PFFS plan works differently than a Medicare supplement plan. The federal government approves PFFS plans to be in place of Original Medicare so that people with Medicare have other options. PFFS plans are not a Medicare supplement, Medigap, Medicare Select or Prescription Drug Plan. In addition, PFFS plans can also offer benefits with predictable member cost sharing on hospital and other physician services. A provider must agree to accept the plan’s terms and conditions of payment prior to providing health care services to members, with the exception of emergencies. If the provider does not agree to accept the plan's terms and conditions of payment, he or she may not provide health care services to members, except in emergencies. WellCare PFFS terms and conditions of payment are posted on this Web site. Concert, Sonata, Prelude and Melody are PFFS plans offered by WellCare Health Plans under a contract with the Centers for Medicare and Medicaid Services (CMS). Some PFFS plans offer drug coverage. Here's more about these plans. Who is Eligible?
Almost anyone eligible for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) is eligible to join one of the WellCare PFFS plans as long as he/she lives in the service area. The only eligibility exception includes Medicare beneficiaries with End Stage Renal Disease (ESRD) prior to enrollment. Once enrolled in a WellCare PFFS plan, a member cannot be disenrolled for any medical condition. Health Care Providers:
There are no provider networks, therefore a list of providers is not applicable, however, we have participating providers that includes dental, hearing and vision coverage. Members are not limited to a service area, state or region to obtain their care. Unlike HMOs, a PFFS plan does not require the designation of a Primary Care Physician (PCP). However, WellCare does request that applicants identify their primary providers so that WellCare PFFS plan can mail educational materials about the plan to both members and providers. For product education or information, please contact the Provider Service Center at 1-866-235-2770, (TTY/TDD: 1-866-239-6265) Monday-Sunday, 7 am to 2am Eastern. |
