2018 Quick Reference Guide
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1 Effective: AARP MedicareComplete (HMO): H & H AARP MedicareComplete Choice (PPO): H AARP MedicareComplete Choice (PPO): H AARP MedicareComplete Choice Plan 2 (Regional PPO): R AARP MedicareComplete Choice Essential (Regional PPO): R CHIROPRACTIC Optum Network WellCare Network CONTRACTING contracthelpdesk@wellmed.net Fax: contracthelpdesk@wellmed.net Fax: COMPLIANCE Fraud & Abuse Hotline: Compliance Officer: compliance@wellmed.net Secure CLAIMS ADDRESS Clearinghouse: Optum Insight Routing #: WELM2 Fraud & Abuse Hotline: Compliance Officer: compliance@wellmed.net Secure Clearinghouse: RelayHealth (McKesson) Routing #: WellMed Networks Inc. Claims Department P.O. Box San Antonio, TX Claims status can be viewed at: DENTAL UHC Dental: Applies to Benefit Plans: H , H & H DIABETIC SUPPLIES diabeticsupplyteam@wellmed.net Phone: Fax: DIAGNOSTIC / ADVANCED RADIOLOGY EviCore Phone: Prior Authorization required for: PET, Nuclear Medicine DIAGNOSTIC / CARDIOLOGY EviCore Phone: Prior Authorization required for: Pacemakers, Myocardial Perfusion Imaging (SPECT), Stress Echocardiography, Implantable Cardioverter Defibrillators (ICD), Diagnostic Heart Catherizations WellCare Health Plans Claims Department P.O. Box Tampa, FL Questions related to claims submissions: Liberty Dental: Providers: Pharmacy Services Phone: Including after-hours/weekends (CVS/Caremark) Exactus Pharmacy Solutions (Specialty): Fax: Secure exactus@wellcare.com EviCore Phone: EviCore Phone: of 5
2 Effective: AARP MedicareComplete (HMO) AARP MedicareComplete Choice (PPO) AARP MedicareComplete Choice Plan 2 (Regional PPO) AARP MedicareComplete Choice Essential (Regional PPO) DURABLE MEDICAL EQUIPMENT Contracted Network WellCare Network for Prior Auth Fax: HEARING hi HealthInnovations: Hear USA for Prior Auth: Phone: Fax: HOME HEALTH Contracted Network I No Referral Required WellCare Network for Prior Auth Fax: LABORATORY LabCorp: Quest: BEHAVIORAL HEALTH WellMed Non-Delegated For Claims MEDICAL ONCOLOGY (Injectable Outpatient Chemotherapy) OptumHealth Behavioral Solutions: EviCore Phone: Prior authorization required Urgent Authorizations and Provider Services: Crisis Line: Outpatient Authorization Request Submissions: Fax: Inpatient Hospitalization Clinical Submissions: Fax: Not Applicable OUTPATIENT PHYSICAL THERAPY No Referral Required Not Applicable PHARMACY (Drug Inquiries) PHARMACY (Mail Order) PRIOR AUTHORIZATION OptumRx: Prior Authorization (Physicians): Phone: Option 1 - Oral/Topical Option 2 - Injectable Fax: OptumRx: Mail Service Pharmacy, Speciality Supplies, and Specialty Pharmacy Phone: Fax: WellMed Utilization Management: eprg: Phone: Fax: Please reference the UHC Admin Guide located in eprg(provider Resources/WellMed Florida). Pharmacy Services Phone: Including after-hours/weekends (CVS/Caremark) Exactus Pharmacy Solutions (Specialty): Fax: Secure exactus@wellcare.com CVS/Caremark Mail Service: Phone: Fax: WellCare Urgent Authorization Requests and Admission Notifications: Durable Medical Equipment (DME) and Home Health Services: Fax: Orthotics and Prosthetics: Fax: Inpatient Services: Fax: Outpatient Services: Fax: Skilled Therapy Services: Fax: of 5
3 Effective: AARP MedicareComplete (HMO) AARP MedicareComplete Choice (PPO) AARP MedicareComplete Choice Plan 2 (Regional PPO) SPECIALTY REFERRAL AARP MedicareComplete Choice Essential (Regional PPO) PCP Must Submit Specialty Referral through the secure provider portal eprg: Applies to Benefit Plans: H & H Please reference the WellMed Florida Specialty Protocol List located in eprg (Provider Resources/WellMed Florida). Not Applicable SECURE PROVIDER PORTAL eprg: WellMed eprg: WellCare: TRANSPORTATION Comfort Care: * *Transportation is not a health plan benefit, but is offered to members who are assigned to a WelllMed Primary Care Physician (PCP). Schedule 3 days in advance, Limits may apply MTM: Benefit limits may apply VISION (Exam/Hardware) UHC Vision: Premier Eye Care: Vision benefits vary. Please contact WellCare Provider Services to verify coverage VISION (Ophthalmology) UHC Vision: Premier Eye Care: Vision benefits vary. Please contact WellCare Provider Services to verify coverage PROVIDER RELATIONS WellMed Florida: Phone: (Press: #3 for Greater Tampa) Specialists/Ancillary: WellMed Florida: Phone: (Press: #3 for Greater Tampa) Specialists/Ancillary: *Please reference for complete information. 3 of 5
4 AARP MedicareComplete (HMO): H & H SAMPLE MEMBER ID CARDS AARP MedicareComplete Choice (PPO): H AARP MedicareComplete Choice (PPO): H The member ID cards represented on this page are sample ID cards. Please refer to the patient s actual ID card for the most accurate information. 4 of 5
5 SAMPLE MEMBER ID CARDS AARP MedicareComplete Choice Plan 2 (Regional PPO): R AARP MedicareComplete Choice Essential (Regional PPO): R WellCare The member ID cards represented on this page are sample ID cards. Please refer to the patient s actual ID card for the most accurate information. 5 of 5
2018 Quick Reference Guide
Effective: 01-01-2018 AARP MedicareComplete (HMO): H1045-030 & H1045-043 AARP MedicareComplete Choice Plan 2 (Regional PPO): R7444-003 AARP Medicare Complete Choice Essential (Regional PPO): R7444-004
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://eoc.anthem.com/eocdps/aso or by calling (855) 333-5735.
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Blue Cross Silver, a Multi-State Plan 87 An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within BCBSM s unsurpassed statewide
UFCW: Self-Funded Comprehensive Medical Plan Two Coverage Period: 03/01/ /31/2017 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.hma-hi.com or by calling 1-866-331-5913. If you
$0 See the chart starting on page 2 for your costs for services this plan covers.
This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.teamsters-hma.com or by calling 1-877-384-2875.
Important Questions Answers Why This Matters:
HealthFlex: Blue Cross and Blue Shield of Illinois Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: All Tiers Plan Type: PPO