2018 Quick Reference Guide
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- Miranda Day
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1 Effective: AARP MedicareComplete (HMO): H & H AARP MedicareComplete Choice Plan 2 (Regional PPO): R AARP Medicare Complete Choice Essential (Regional PPO): R UnitedHealthcare The Villages Medicare Complete (HMO): H UnitedHealthcare The Villages Medicare Complete 2 (HMO): H AARP MedicareComplete Choice (PPO): H 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 #: DENTAL DIABETIC SUPPLIES DIAGNOSTIC / ADVANCED RADIOLOGY WellMed Networks Inc. Claims Department P.O. Box San Antonio, TX Claims status can be viewed at: UHC Dental: Only Applies to Benefit Plans: H & H All Other Plans: No Benefit diabeticsupplyteam@wellmed.net Phone: Fax: EviCore Phone: Prior Authorization required for: PET, Nuclear Medicine WellCare Health Plans Claims Department P.O. Box Tampa, FL Claim submissions questions: Liberty Dental: Providers: Members: Pharmacy Services Phone: Including after-hours/weekends (Catamaran) Exactus Pharmacy Solutions (Specialty Phone): Fax: exactus@wellcare.com Web: EviCore Phone: Fax: of 5
2 Effective: AARP MedicareComplete (HMO) AARP MedicareComplete Choice Plan 2 (Regional PPO) AARP Medicare Complete Choice Essential (Regional PPO) UnitedHealthcare The Villages Medicare Complete (HMO) UnitedHealthcare The Villages Medicare Complete 2 (HMO) AARP MedicareComplete Choice (PPO) DIAGNOSTIC/ CARDIOLOGY EviCore Phone: Prior Authorization required for: Pacemakers, Myocardial Perfusion Imaging (SPECT), Stress Echocardiography, Implantable Cardioverter Defibrillators (ICD), Diagnostic Heart Catherizations DURABLE MEDICAL EQUIPMENT HEARING EviCore Phone: Fax: Contracted Network WellCare Network for Prior Auth Fax: 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 OptumHealth Behavioral Solutions: MEDICAL ONCOLOGY (Injectable Outpatient Chemotheraphy) OUTPATIENT PHYSICAL THERAPY PHARMACY (Drug Inquiries) PHARMACY (Mail Order) EviCore Phone: Prior authorization required No Referral Required OptumRx: Prior Authorization (Physicians) Phone: Option 1 - Oral/Topical Option 2 - Injectable Fax: OptumRx: Mail Service Pharmacy, Speciality Supplies, and Specialty Pharmacy Phone: Fax: Urgent Authorizations and Provider Services: Crisis Line: Outpatient Authorization Request Submissions: Fax: Inpatient Hospitalization Clinical Submissions: Fax: Pharmacy Services Phone: Including after-hours/weekends (Catamaran) Exactus Pharmacy Solutions (Specialty): Fax: Secure exactus@wellcare.com CVS/Caremark Mail Service: Phone: Fax: of 5
3 Effective: AARP MedicareComplete (HMO) AARP MedicareComplete Choice Plan 2 (Regional PPO) AARP Medicare Complete Choice Essential (Regional PPO) PRIOR AUTHORIZATION SPECIALTY REFERRAL UnitedHealthcare The Villages Medicare Complete (HMO) UnitedHealthcare The Villages Medicare Complete 2 (HMO) AARP MedicareComplete Choice (PPO) WellMed Utilization Management: eprg: Phone: Fax: Please reference the UHC Admin Guide located in eprg(provider Resources/WellMed Florida). PCP Must Submit Specialty Referral through the secure provider portal eprg: Only Applies to Benefit Plan H Please reference the WellMed Florida Specialty Protocol List located in eprg (Provider Resources/WellMed Florida). 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: 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: #2 for Greater Orlando-Lake, Marion, Orange, Osceola, Seminole, Sumter and Volusia Counties) Specialists/Ancillary: , WellMed Florida: Phone: (Press: #2 for Greater Orlando-Lake, Marion, Orange, Osceola, Seminole, Sumter and Volusia Counties) Specialists/Ancillary: , *Please reference for complete information. 3 of 5
4 2018 Quick Reference Guide SAMPLE MEMBER ID CARDS UnitedHealthcare The Villages Medicare Complete (HMO) H AARP MedicareComplete (HMO): H AARP MedicareComplete Choice Plan 2 (Regional PPO): R UnitedHealthcare The Villages Medicare Complete 2 (HMO) H AARP MedicareComplete (HMO): H AARP MedicareComplete Choice Essential (Regional PPO): R 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 AARP MedicareComplete Choice (PPO): H Quick Reference Guide SAMPLE MEMBER ID CARDS 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
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