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WellCare PFFS Plans Discontinued for 2010
WellCare notified the Centers for Medicare & Medicaid Services (CMS) that it would not renew its contracts to offer Medicare Advantage Private Fee-for-Service (PFFS) plans in 2010. This decision affected all WellCare PFFS plans, including those referred to as Concert, Melody, Melody-Plus, Prelude, Quartet, Sonata, Sonata-Plus and Serenade. These plans were discontinued on January 1, 2010.
Providers may continue to bill, according to CMS' timely filing guidelines (see new guidelines), for covered services rendered through December 31, 2009.
WellCare's decision to discontinue offering PFFS plans does not affect WellCare Medicare HMO (coordinated care) and prescription drug plan (PDP) members or Medicaid members.
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WellCare PFFS is committed to support your efforts by offering:
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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–Friday, 8am to 8pm Eastern.
WellCare Concert, WellCare Melody, WellCare Melody-Plus, WellCare Prelude, WellCare Quartet, WellCare Serenade, WellCare Sonata and WellCare Sonata-Plus are Medicare Advantage Private Fee-for-Service (PFFS) plans offered by WellCare Health Plans, Inc. under a contract with the Centers for Medicare & Medicaid Services (CMS) for the 2009 plan year.
Some PFFS plans offer drug coverage. Here's more about these plans .
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. PFFS plans allows members to use any provider, such as a physician, health professional, hospital or other Medicare provider in the United States that agrees to treat the member after having the opportunity to review these terms and conditions of payment, as long as the provider is eligible to provide health care services under Medicare Part A and Part B (also known as ‘Original Medicare’) or eligible to be paid by WellCare PFFS for benefits that are not covered under Original Medicare.
The law provides that if you have an opportunity to review these terms and conditions of payment and you treat a WellCare PFFS member, you will be “deemed” to have a contract with us.
If you DO NOT wish to accept WellCare PFFS terms and conditions of payment, then you should not furnish services to a WellCare PFFS member, except for emergency services. If you nonetheless do furnish non-emergency services, you will be subject to these terms and conditions whether you wish to agree to them or not. Providers furnishing emergency services will be treated as non-contract providers and paid at the payment amounts they would have received under Original Medicare.
What is a Network Private Fee-for-Service (PFFS) Plan?
WellCare offers two plans, WellCare Melody-Plus and WellCare Sonata-Plus that offer a network of Primary Care Physicians (PCPs). These plans may offer a lower in-network co-payment.
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.
Additional Information
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-Friday, 8am to 8pm Eastern.
Marketing Guidelines
The Centers for Medicare & Medicaid Services (CMS) has strict Medicare marketing guidelines that are critical for WellCare to maintain. Medicare marketing guidelines apply to WellCare as well as its agents, providers and downstream entities. If you are a provider, please follow the basic rules below.
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Do comply with Medicare Marketing Guidelines as provider specific guidelines define how providers may assist beneficiaries with plan selection, while ensuring plan selection is in the best interests of the beneficiary. | Don’t steer or attempt to steer an undecided potential enrollee toward a plan, or limited number of plans based on the financial interest of the provider. |
Do assist a beneficiary in an objective assessment of the beneficiary’s needs and potential plan options that may meet those needs. | Don’t use any affiliation communication materials that describe plans in any way (e.g., benefits, formularies) without prior approval from the plan sponsor. Note: these materials must have CMS-approval prior to distribution. |
Do inform beneficiaries where they may obtain information on the full range of plan options by directing beneficiaries to other sources of information, such as the State Health Insurance Assistance Programs, plan toll free information lines, their State Medicaid Office, local Social Security Administration Office, http://www.medicare/gov/ or 1-800-MEDICARE. | Don’t steer or attempt to steer an undecided potential enrollee toward a plan, or limited number of plans based on the financial interest of the provider. |
Do work with the plan sponsor to announce affiliations and contractual arrangements to beneficiaries. | Don’t announce affiliations and contractual arrangements to beneficiaries without first working with the plan sponsor. Subsequent announcements must include all provider plan affiliations. |
