Information and Resources on Hurricane Helene. Are you in North Carolina and need help because of Hurricane Helene? View the DPS website for helpful information.
Provider Toolkit: Quick Reference Guide
Simplify Office Administrative Tasks
Keep our Quick Reference Guide nearby to make pre-visit planning and post-visit tasks quick and easy.
- Verify member eligibility
- Access patient health records
- View patient gaps
- Manage prior authorizations
- Submit and manage claims
- And more!
Member Eligibility
Check member eligibility via:
- Secure Web Portal
- 24/7 Toll-Free Interactive Voice Response (IVR) Line: 1-833-925-2861
- Provider Services: 1-833-925-2861
Patient Care Gaps
Find recommended services that a member has not completed.
- Visit the Secure Provider Portal.
- Review patient informationfor any gaps in care.
- Plan to address care gapsduring future appointment.
Prior Authorization
Use the Pre-Auth Needed tool on our website to determine if prior authorization is required.
Submit prior authorizations via:
- Secure Provider Portal
- Medical Fax (Outpatient): 1-833-897-0322
- Behavioral Fax (Outpatient): 1-833-538-2372
- Medical Fax (Inpatient): 1-833-897-0322
- Behavioral Fax (inpatient): 1-833-538-2371
- Transplant: 1-833-897-0327
Claims
Timely Filing guidelines: 180 days from date of service.
Claims can be submitted via:
- Secure Portal
- Clearinghouses: EDI Payor ID 68069
- Mail paper claims to: WellCare Health Plans Attn: Claims Department P.O. Box 31224 Tampa, FL 33631-3224
- Verify member eligibility.
- Check for patient care gaps and address them during upcoming office visit.
- Use Pre-Auth Needed tool to determine if prior authorization is needed before appointment.