Provider Newsletter contains information on a variety of topics that we hope can be of value to you, your practice, and your patients. (Please note: The Provider Service Center operation hours reflected in this version of the newsletter have been revised. The new hours are Monday-Friday, 8am to 8pm EST.) 2009 Provider Resource Guide includes important information to keep you and your staff informed and assist you in providing a positive patient experience. (Please note: The Provider Service Center operation hours reflected in this version of the guide have been revised. The new hours are Monday-Friday, 8am to 8pm EST.) 2009 Quick Reference Contact Guide for the Private Fee-for-Service (PFFS) plans provides you with important contact and address information in a quick reference format. (Please note: The Provider Service Center operation hours reflected in this version of the guide have been revised. The new hours are Monday-Friday, 8am to 8pm EST.) |  |
Some of these documents are currently in the process of being updated. We apologize for any inconvenience this may cause. Please contact our Provider Service Center at 1-866-235-2770 (TTY/TDD: 1-866-239-6265) Monday-Friday, 8am to 8pm EST with any questions you may have regarding our plans.
CMS COMMON WORKING FILE AND PRIVATE FEE-FOR-SERVICE These documents provide confirmation that WellCare PFFS is contracted with CMS as a PFFS plan, not an HMO. Common working file letter PROVIDING MEMBERS WITH NOTICE OF THEIR APPEALS RIGHTS —REQUIREMENTS FOR HOSPITALS, SNFS, CORFS AND HHAS Hospitals must notify Medicare beneficiaries who are hospital inpatients about their discharge appeal rights by complying with the requirements for providing the Important Message from Medicare (IM), including the time frames for delivery. For copies of the notice and additional information regarding this requirement, go to: www.cms.hhs.gov/BNI/12_HospitalDischargeAppealNotices.asp
Skilled nursing facilities, home health agencies and comprehensive outpatient rehabilitation facilities must notify Medicare beneficiaries about their right to appeal a termination of services decision by complying with the requirements for providing Notice of Medicare Non-Coverage (NOMNC), including the time frames for delivery. For copies of the notice and the notice instructions, go to: www.cms.hhs.gov/MMCAG/Downloads/NOMNCForm.pdf and www.cms.hhs.gov/MMCAG/Downloads/NOMNCInstructions.pdf. In addition, the provider should send a copy of any NOMNC issued to P.O. Box 31490, Tampa, FL 33631-3490 or fax to 1-813-464-8764.
WellCare PFFS will provide members with a detailed explanation if a member notifies the Quality Improvement Organization (QIO) that the member wishes to appeal a decision regarding a hospital discharge or termination of home health agency, comprehensive outpatient rehabilitation facility or skilled nursing facility services within the time frames specified by law. | |
