Provider

 

Welcome, Providers

It is WellCare’s mission to enhance our members’ health and quality of life and partner with providers and government agencies to provide quality, cost-effective health care solutions to the members we are privileged to serve. With the intent to further this mission in New Jersey, WellCare was approved to begin serving Medicaid members in New Jersey effective December 2013. We've since acquired Healthfirst Health Plans of New Jersey’s Medicaid members, and launched the Managed Long Term Services and Supports (MLTSS) programboth effective July 1, 2014.

 

Getting Started
The following guides contain information about how to verify member eligibility, submit claims, request authorizations, and more.


Join WellCare
Please complete our provider form or contact us for more information or to learn how to join our network.
 

CareCore National Expansion
WellCare currently collaborates with CareCore National to provide prior authorization for advanced radiology, cardiology, sleep management and pain management requests. Effective August 18, 2014, our partnership will expand to include certain Molecular and Genetic Laboratory Tests, Radiation Therapy, and Outpatient Occupational and Physical Therapy.

 

Medicaid Post-Pay Inpatient Readmissions
WellCare has implemented a process of reviewing and adjusting claims payments for inpatient admissions that are deemed to be a readmission.

 

Provider Resources
Please visit our resources area for important information, materials and forms.
 

Secure Provider Portal
Register for our secure portal to check eligibility, request authorizations, submit claims, complete required training and more.


 

Last modified: 03/03/2015
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