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.
Forms and Documents
Template forms and documents for appeals, authorizations, claims, pharmacy services and more.
Clinical Coverage Guidelines(Redirects 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 (Redirects 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.
Training and Education Materials (Redirects to our corporate website)
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.
Quarterly newsletters to provide current information on pharmaceuticals, cost and quality of care, to share tips on how to perform processes more efficiently with the plan, and to highlight recent successes, such as accreditations and quality scores.
Provides updates on WellCare's claims processes, ensuring that provider claims are handled efficiently.
Some links associated in the section above require the ability to open .pdf files. If for any reason you are not able to view these links, please download the reader software.