On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.
Wellcare is ready to become your Medicare partner!
The Annual Enrollment Period for your Medicare patients runs from October 15 to December 7. Your patients have a choice in their Medicare health insurance, and we hope that they will use this Annual Enrollment Period to get acquainted with Wellcare. If they ask you about their coverage options, let them know you accept Wellcare.
As our partner, you can count on our complete support as you continue to focus on providing compassionate and expert care to your patients. Our most helpful provider resources include:
Further provider resources, including dedicated Provider Relations and Contracting contacts, can be found on the Nebraska Total Care’s website at www.nebraskatotalcare.com/providers.html. Wellcare is the Medicare product offered through Nebraska Total Care.
Questions?
- Non-Duals/C-SNP 1-800-977-7522 (TTY: 711)
- Duals/D-SNP 1-844-796-6811 (TTY: 711)
Effective January 1, 2023, fax attestations are no longer accepted
Special Supplemental Benefits for Chronically Ill (SSBCI) are offered to Wellcare’s highest-risk members who meet specific criteria for eligibility based on the Centers for Medicare and Medicaid Services (CMS) guidelines.
Effective January 1, 2023, you can check eligibility requirements and submit attestations on behalf of members online at ssbci.rrd.com.
Steps to determine eligibility, submit attestations and activate benefits
Members are required to schedule an office visit with their doctor or participating physician group for evaluation. Once appointment is made follow the steps below:
- Visit ssbci.rrd.com.
- Follow the steps on ssbci.rrd.com to evaluate your patient against the eligibility requirements outlined on ssbci.rrd.com.
- Submit an attestation form through ssbci.rrd.com indicating your patient meets the eligibility requirements.
- Submit a claim with the appropriate diagnosis codes from this office visit indicating a member has been diagnosed with one or more qualifying chronic conditions listed on ssbci.rrd.com.
- Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days. Approval letters include information on steps the member should follow to activate supplemental member benefits.
If you have questions regarding the information contained in this update, contact your dedicated Provider Relations Representative with the health plan.
- Provider Medicine Request Checklist (PDF)
- Prior Authorization Information (PDF)
- Wellcare Health Plans Utilization Review Matrix 2021 (PDF)
- Provider Outreach and Clinical Engagement Strategy for Wellcare (PDF)
FAQ's-
- National Imaging Associates FAQ's For Wellcare Providers (PDF)
- National Imaging Associates FAQ's Wellcare Prior Authorization Physical Medicine (PDF)
Cardiac-
- Cardiac Checklist (PDF)
- Cardiac Imaging Frequently Asked Questions (PDF)
- Cardiac Solution Program Tip Sheet MPI vs. SE (PDF)
Quick Reference Guides-
For Medicare information, please visit our Medicare Prior Authorization website.
- Distinct Procedural Service: Modifier 59 (PDF) Effective 1/17/2023
- Robotic Surgery (PDF) Effective 1/1/2022
- CC.PP.206 Skilled Nursing Facility Leveling (PDF) Effective Date 01/01/2024
- MC.CP.MP.101 Donor Lymphocyte Infusion (PDF) Effective Date 01/01/2024
- MC.CP.MP.106 Endometrial Ablation (PDF) Effective Date 01/01/2024
- MC.CP.MP.108 Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and ß-Thalassemia (PDF) Effective Date 01/01/2024
- MC.CP.MP.160 Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF) Effective Date 01/01/2024
- MC.CP.MP.170 Peripheral Nerve Blocks (PDF) Effective Date 01/01/2024
- MC.CP.MP.182 Short Inpatient Hospital Stay (PDF) Effective Date 01/01/2024
- MC.CP.MP.22 Stereotactic Radiation Therapy (PDF) Effective Date 01/01/2024
- MC.CP.MP.246 Pediatric Kidney Transplan (PDF) Effective Date 01/01/2024
- MC.CP.MP.57 Lung Transplantation (PDF) Effective Date 01/01/2024
- MC.CP.MP.69 Intensity Modulated Radiation Therapy (IMRT) (PDF) Effective Date 01/01/2024
- Concert Genetics Genetic Testing: Aortopathies and Connective Tissue Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Cardiac Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Dermatologic Conditions (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Eye Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous) (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: General Approach to Genetic Testing (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Hearing Loss (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Hematologic Conditions (non-cancerous) (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Hereditary Cancer Susceptibility (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Kidney Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Lung Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Non-invasive Prenatal Screening (NIPS) (PDF) Effective Date 01/01/2024
- Concert Genetics Oncology: Algorithmic Testing (PDF) Effective Date 01/01/2024
- Concert Genetics Oncology: Cancer Screening (PDF) Effective Date 01/01/2024
- Concert Genetics Oncology: Circulating Tumor DNA and Circulating Tumor Cells (PDF) Effective Date 01/01/2024
- Concert Genetics Oncology: Cytogenetic Testing (PDF) Effective Date 01/01/2024
- Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Pharmacogenetics (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Preimplantation Genetic Testing (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Prenatal and Preconception Carrier Screening (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss (PDF) Effective Date 01/01/2024
- Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders (PDF) Effective Date 01/01/2024
- CG.CP.MP.01 Infectious Disease: Respiratory Lab Testing (PDF) Effective Date: 07/01/2024
- CG.CP.MP.02 Infectious Disease: Multi-System Lab Testing (PDF) Effective Date: 07/01/2024
- CG.CP.MP.03 Infectious Disease: Dermatologic Testing (PDF) Effective Date: 07/01/2024
- CG.CP.MP.04 Infectious Disease: Gastroenterologic Lab Testing (PDF) Effective Date: 07/01/2024
- CG.CP.MP.05 Infectious Disease: Primary Care & Preventative Lab Screening (PDF) Effective Date: 07/01/2024
- CG.CP.MP.06 Infectious Disease: Vector-Borne and Tropical Disease Lab Testing (PDF) Effective Date: 07/01/2024
- CG.CP.MP.07 Infectious Disease: Genitourinary Lab Testing (PDF) Effective Date: 07/01/2024
- Concert Genetic Lab Testing Clinical Criteria Support (PDF)
- CP.MP.97 Testing for Select Genitourinary Conditions (PDF)
- MC.CP.MP.249 Omisirge 6/30/2024
- MC.CP.MP.250 Lantidra 7/31/2024
- MC.CP.MP.31 Cosmetic and Reconstruction Procedures 8/31/2024
- MC.CP.MP.166 Sacroiliac Joint Interventions for Pain Management 8/31/2024
- CP.MP.248 Facility-based Sleep Studies for Obstructive Sleep Apnea Effective Date: 01/01/2025
- CP.MP.96 Ambulatory EEG (PDF)
- CP.MP.106 Endometrial Ablation (PDF)
- CP.MP.113 Holter Monitors (PDF)
- CP.MP.149 PROM Testing
- CP.MP.54 Hospice Services (PDF)
- CC.PP.500 3 Day Payment Window (PDF)
- CC.PP.070 340B Drug Payment Reduction (PDF)
- OC.UM.CP.0026 Extended Ophthalmoscopy (PDF)
- OC.UM.CP.0043 External Ocular Photography (PDF)
- OC.UM.CP.0028 Fluorescein Angiography (PDF)
- OC.UM.CP 0031 Gonioscopy (PDF)
- CC.PP.065 Multiple Diagnostic Cardiovascular Procedure Payment Reduction (MDCR) (PDF)
- CC.PP.069 Multiple Procedure Reduction: Ophthalmology (PDF)
- CC.PP.061 Non-Obstetrical and OB Pelvic and Transvaginal Ultrasounds (PDF)
- OC.UM.CP.0014 Scanning computerized Ophthalmic Diagnostic Imaging (SCODI) (PDF)
- CC.PP.035 Sleep Studies Place of Service (PDF)
- CC.PP.056 Urine Speciment Validity Testing (PDF)
- OC.UM.CP.0063 Visual Field Testing (PDF)
- CC.PP.502 Wheelchairs Accessories (PDF)
- CC.PP.501 30 Day Readmission (PDF)
- CC.PP.066 Leveling of Care: Evaluation and Management Overcoding (PDF)
- CC.PP.053 Non-Emergent ER Services (fka Leveling of ER Services) (PDF)
- CC.PP.054 Physician's Consultation Services (PDF)
- CC.PP.057 Problem-Oriented Visits with Preventative Visits (PDF)
- CC.PP.052 Problem-Oriented Visits with Surgical Procedures
- CC.PP.020 Distinct Procedural Modifiers: XE, XS, XP, & XU (PDF)
- CC.Pl.04 Clean Claim Reviews (PDF)
- CC.Pl.06 Cost to Charge Adjustments on Clean Claim Reviews (PDF)
- CC.Pl.10 Unbundling Adjustments on Clean Claim Reviews (PDF)
- CC.PP.014 District Procedure Mod 59
- CC.PP.031 CMS Correct Coding Initative Unbundling Edits (PDF)
- CG.CC.PP.01 Concert Laboratory Payment Policy (PDF) Effective Date: 07/01/2024
- CG.PP.551 Genetic and Molecular Testing (PDF) Effective Date: 07/01/2024
- CC.PP.206 Skilled Nursing Facility Leveling Effective Date: 08/31/2024