What to Expect with CMS managed by WellCare
If you haven’t heard by now then I’m sorry to say it’s going to be a rough couple of months for your practice. WellCare/Staywell won the contract to manage Florida’s statewide CMS program and will assume all responsibility on February 1st, 2019 (yep, about a week from this writing).
Transitions almost always have their share of difficulties and being prepared to tackle those challenges is the best defense to ensure we always get paid for our hard work. This transition will be no different and we’ve already seen a few issues along the way as portions of the state’s MMA program have fallen under WellCare’s Medicaid line of business. That said, I’ve been extremely impressed with the communication and reactiveness from the WellCare staff to fix our issues as soon as they arise.
What will change?
1. Authorizations for all CMS patients after 2/1/19 need to be submitted by fax, phone, or through either the WellCare Provider Portal (ST Only) or the EviCore Portal (OT and PT). You will no longer use MED3000 or CCP to administer your CMS patients.
2. Eligibility for CMS Title XXI patients will only be available on the WellCare Provider Portal. Title XIX will continue to be available on the Medicaid Web Portal.
3. For CMS claims, you will submit them via paper or electronically to WellCare starting on 2/1/19 using the WellCare payor ID: 14163.
What steps does your practice need to take?
1. If you haven’t already, sign up for the WellCare Provider Portal and EviCore Portal ASAP so you’re prepared to submit authorizations and check eligibility on 2/1/19.
a. WellCare Portal Web Address: https://provider.wellcare.com/provider/login?ReturnUrl=%2fProvider%2fCareManagement%2fCareManagementHome
b. EviCore Portal Web Address: https://www.evicore.com/pages/providerlogin.aspx
2. Verify patient’s eligibility ASAP on 2/1/19; if your CMS patient doesn’t show up on the WellCare Portal right away then send a list of those inactive patients to your WellCare provider rep as soon as possible to verify their eligibility and in my experience, they will respond right away.
3. Submit ALL your authorizations on 2/1/19. Why?! Because WellCare doesn’t backdate authorizations and while there is a Continuity of Care clause your claims may be denied at first because of no authorization. As long as you have an existing auth with CMS, you will get paid but you should spend the extra time up front to submit authorizations so you get paid as quickly as possible.
4. Sign up for Payspan and set up your EFT and ERA delivery options. This will ensure you get paid faster and more reliably once claims begin to process.
a. PaySpan Web Address: https://www.payspanhealth.com/nps/login.aspx#/
What are the ongoing challenges that need to be addressed by all providers?
1. Something that could become a larger issue in the near future is that WellCare is out-of-network for Office Ally and Availity claims clearinghouses. That doesn’t mean they won’t submit your claims but both clearinghouses charge fees when the bulk of your claims are out of their network. What can we do? Write your provider rep and let them know that they need to be “In-Network” with these clearinghouses as soon as possible.
2. At the time of this writing, WellCare does not backdate authorizations more than 5 days and even then, it can be difficult to get them backdated. This is something providers have become accustomed to with CMS who backdates up to 90 days and could present a problem if your therapists treat patients without auth. What can we do? Write your provider rep and let them know that this needs to change. They do know about the concern but we need more support to show how important it is for continuity of care for our patients.
What is the positive news; if any?
1. First and Foremost, credentialing is so much quicker and easier! Anyone who has worked with CMS under CCP knows that the process was taking 6-9 months to complete. On the contrary, I’ve seen WellCare credential providers in under 45 days and the application process is clearer and simpler.
2. From what I’ve experienced so far in transitioning two regions, WellCare has a proactive and responsive team who is eager to resolve problems as they arise. They won a big contract with the State of Florida and they want to manage it well so communicate your issues early and often and I believe they’ll work with you to resolve them.
3. For most OT/PT auths, you will receive immediate approvals from EviCore. The auth process is a bit more complicated to submit but, in most cases, you’ll get an approval on the same day; much faster than when the program was managed by CCP.
4. From experience, WellCare seems to process claims a little bit faster than CMS managed under CCP. We would often see delays of 3 weeks with CMS under CCP but payments from WellCare seem to happen within 7-10 days of receipt.
Who to Contact if you experience issues:
With WellCare reach out to Duenna Dorsett (Senior Director of Provider Relations) and she will put you in touch with the correct provider rep: her email is Duenna.Dorsett@wellcare.com.
For EviCore reach out to Vycki Rupakus (Director, Therapy Provider Engagement) and she will help resolve your issues with that system: her email is vrupakus@evicore.com.
Well that’s all for now, I hope this helps for a smooth transition with all your CMS kiddos!
Aaron