Wellcare

Changes in Peer-to-Peer Review Request Requirement 
Starting from October 1, 2022, Wellcare is going to bring some changes to the peer-to-peer review request requirements. The Wellcare team believes that this change will minimize the administrative costs on the provider partners.  

Here are the changes at a glance.  

• After Integrated Denial Notice or day of discharge, peer-to-peer review requests will be allowed for up to two business days.  
• Peer-to-peer outreach should be completed within two business days of the review request. 
• A voice mail (with 01 day response time) can be left if for any reason the provider isn’t reached. 
• If no response is received within the set timeframe, Wellcare will not be able to proceed with the peer-to-peer request.  

No changes are being made to existing peer-to-peer timeframes.  
Source: https://www.wellcare.com/en/Providers

CareCentrix Home Health Provider Notification 
In order to manage home health services for Medicare and SNP members in NY, Wellcare Health Plans has initiated a contract with CareCentrix effective October 1, 2022. 
Claims will be denied after the above-mentioned date if home health providers don’t obtain authorization from CareCentrix for Medicare and SNP home health services.  
The new claim process and training schedule will be communicated to the providers by CareCentrix in due time. On top of that, there is a dedicated support number 1-833-444-9089 to answer your queries about the changes. 
Now, let’s look at some key details:

• All authorizations for Medicare and SNP home health services will be managed by CareCentrix. 
• CareCentrix will also manage a network of independent home health agencies for Medicare and SNP members.  
• No hospital-owned home health agencies for Medicare and SNP members are in the purview of CareCentrix. 
• Independent home health agencies can render services regarding claims for Medicare and SNP home health services. CareCentrix will manage these claims.  
• To remain a participating provider, independent home health agencies must enter into the new contract prior to October 1, 2022, directly with CareCentrix.  
• These changes have no impact on the authorizations, contracts or claims for other lines of business with Wellcare.