Provider : Resources

The resources below will assist you in working with WellCare (the Plan).  Click on the links below to access more information.  Please note: the materials accessed online are the most current and up-to-date available.  

• Provider Manuals
  An extension of the Participation Agreement and a resource that provides guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide and other reference resources.

• Provider Quick Reference Guides
  Provide WellCare contact information and authorization guidelines. 

• Medicare Provider Forms and Documents
  Template forms and documents for appeals, authorizations, claims, pharmacy services and more.  

• Medicaid Provider Forms and Documents
  Template forms and documents for appeals, authorizations, claims, pharmacy services and more.  

• Clinical Coverage Guidelines
  Evidence-based guidelines detailing the medical necessity of, and sets consistent criteria for coverage of, given procedures or technologies to ensure greater consistency and efficiency in clinical decision making.

• Clinical Practice Guidelines
  Best-practice guidelines used to guide efforts in improving the quality of care in our membership.  CPGs are based on available clinical outcome and scientific evidence-based content developed by expert professional and clinical society recommendations.  

• Provider Training and Education Materials
  Educational resources regarding initiatives that require specific actions by providers. You must log in to access required Provider training.  Click here if you are not a registered user. 

• Provider Newsletters 
  Quarterly newsletters to provide current information on pharmaceuticals, cost and quality of care, to share tips on how to perform processes more efficiently with the plan, and to highlight recent successes, such as accreditations and quality scores.

• Provider Job Aids and Resource Guides
  Your one-stop shop for resource documents and instructions on how to perform daily tasks with the Plan.

• Claims Updates
  Provides updates on WellCare's claims processes, ensuring that provider claims are handled efficiently.