Connect Archives

July 2011

Thursday, July 28, 2011

ADMINISTRATIVE CHANGES IN WELLCARE

This is to inform you that effective August 1, 2011; the administrative functions that were performed by Med3000 for HFNI in reference to the WellCare Medicare Advantage contract are transferring from Med3000 back to WellCare. Attached is a letter from WellCare informing the WellCare participating providers of the change including Frequently Asked Questions detailing what to do for some of the changes.

Also, effective August 1, 2011 the nature of the contract between HFNI and WellCare will change. Since inception, HFNI has had a risk based contract with WellCare. HFNI was given a capitation and we managed to that amount. This means we made or lost money on that capitation amount. This contract has existed since May 1, 2002. On August 1, 2011 HFNI will switch to a messenger model contract and WellCare will purchase some administrative services from us. These services include Network Assistance, Delegated Credentialing, Case Management/Medical Home and Risk Adjusted Payment System Cooperation. As you can tell from the services, the local providers, through HFNI, will still be involved in the manner in which care is delivered for this product. Since it is a messenger model, you will be asked to opt-in the product again. This will not cause any change in your current reimbursement or in your status as a participating provider in the WellCare Medicare Advantage product as previously defined in the WellCare Joinder you have already signed. Look for the opt-in document shortly.

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WELLCARE’S AUTHORIZATION REQUIREMENTS AND CASE AND DISEASE MANAGEMENT PROGRAMS

Effective August 1, 2011, WellCare will be taking over certain functions recently managed by MED3000. Please take note of the attached information regarding authorization requirements and their Case and Disease Management programs.

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HISTORY & PHYSICAL FORM CHANGES UNDER 8/1/11 TRANSITION OF WELLCARE CONTRACT FUNCTIONS

Health First Network has been notified by WellCare Health Plan that WellCare does not and will not utilize HFNI’s 2-page H&P Form, nor does WellCare pay any type of financial incentive to Physicians to complete an annual H&P Form on their members.

Please discontinue use of the HFNI/WellCare H&P Form as of dates of service later than 07/31/11.

As Health First Network receives any additional information on contract changes, we will notify you.

WELLCARE QUICK REFERENCE GUIDE & PRE-AUTH. LIST

For Information on WellCare provider services, contact information, pharmacy information and Pre-Auth. requirements, click on the link below for WellCare's 2 page guide.

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HEALTHEASE APPROVED IN SANTA ROSA COUNTY

Health First Network is pleased to announce that HealthEase has been approved by AHCA to provide Medicaid HMO services for Santa Rosa county effective August 1, 2011. You should expect some further communication very shortly in regards to the administration of the product.

BEECHSTREET/MULTI PLAN TERMINATION

Please be informed that the contract between Beech Street and Health First Network will terminate effective 09/01/11. Some of you may have joined this network through a messenger model opt-in agreement with Health First. Should you wish to remain a provider with Beech Street you will have to make your own arrangement directly.