www wellcare.com/flex Login : How to use your OTCHS benefits

www wellcare.com/flex Login : How to use your OTCHS benefits

Please complete the Become a Provider form or Contact Us for more information on how to join the network. If you want to join the Medicaid provider network, please be sure to visit your state-specific Medicaid website to submit a request.

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 Please check your Wellcare welcome letter. You can also use the Contact Us form for additional help.

How do I check the status of a claim?

A: To check claim status, log into the secure provider portal. The secure portal is for participating Wellcare providers that are contracted through Medicaid or Medicare lines of business.

Here are the steps to check a claim status:

1. Once you log into the secure provider portal, navigate to the Claims landing page.

2. Search for the claim in a variety of ways including: WCN Number, Claim Number, Member ID, Provider ID, Member Name and DOB, Medicare ID, Medicaid ID or DCN.

*Note: Certain items will require that you enter a date range under “Service Date”.

3. Select the “Search” button and the claim results will display below.

Does Wellcare provide EFT and ERA services?

Yes. Wellcare Health Plans, Inc. is pleased to offer providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. Offered in partnership with PaySpan Health, you now have access to a secure, quick way to electronically settle claims. Using this no-cost service, providers can settle claims electronically, without making an investment in expensive EDI software.

You can find additional helpful information in your quick-reference guide.

Brokers interested in partnering with Wellcare may contact Broker Support Call Center at 866-822-1339 for further details.

Wellcare is here for you! For support, brokers can contact the Agent Support Call Center, submit an Agent Support Ticket via the Agent Connect Portal, or reach out to dedicated local support. Our local offices have Account Executives, Sales Assistants, and Marketing Outreach Specialists available to offer you real-time support!

When can I enroll or make a plan change into a Prescription Drug Plan?

A: Initial Coverage Election Period

The Medicare Initial Coverage Election Period is based on the month of your 65th birthday. You can enroll as early as three months before your birthday month or as late as three months after your birthday month.

Annual Enrollment Period (AEP)

The Medicare Annual Enrollment Period is from October 15 to December 7, during this time you can:

  • Enroll in a Medicare Part D or Medicare Advantage plan from Original Medicare
  • Enroll from one Medicare Part D or Medicare Advantage plan to another
  • Enroll in original Medicare from a Medicare Advantage Plan

Changes made to coverage during this time would take effect January 1 of the new plan year.

Medicare Advantage Open Enrollment Period (MA OEP)

The Medicare Advantage Open Enrollment Period starts January 1 and ends on March 31. During this period, members enrolled in Medicare Advantage can…

  • If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage)
  • You can drop your Medicare Advantage Plan and return to Original Medicare. You will also be able to join a Medicare Prescription Drug Plan.

The effective date for the Medicare Advantage Open Enrollment Period election is the first day of the month after we receive the enrollment request.

Special Enrollment Periods (SEP)

You could qualify for a Special Enrollment Period during any month when certain events happen in your life. Reasons you could qualify include:

  • You have changed your permanent residence
  • You have recently moved to a new service area
  • You become eligible for Medicaid
  • You qualify for Extra Help with Medicare prescription drug costs
  • You moved to an institution like a skilled nursing facility or long-term care hospital
  • You want to switch to a plan with a 5-star overall quality rating.

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