WellCare Credentialing Services for your Independent Practice

The process through which WellCare’s relevant peer review organizations assess the credentials and qualifications of practitioners such as physicians, allied health professionals, hospitals, surgery centers, home health agencies, and skilled nursing facilities is known as credentialing facilities, as well as ancillary departments and healthcare performance standards. For the sake of All references to “practitioners” in this Credentialing section cover providers, furnishing health or health-related services, such as physicians, allied health professionals, and other hospitals, surgery centers, home health companies, and skilled nursing facilities are all examples of health professions, healthcare delivery organizations/facilities, and other related facilities.

Before being identified as a participating network provider of care or services to WellCare members, practitioners must be accredited.

This assessment comprises the following: (as appropriate to practitioner standard)

• Background;

• Education

• Postgraduate education

• Certification(s)

• Experience

• Work history and manifested an ability

• Patient admitting skills

• Licensure, administrative compliance, and health situation may affect a practitioner’s capacity to afford health care

• Accreditation rank, as relevant to non-individuals

Our Specialist Will Help To Get You Credentialed Now!

We will go along with you to review your educations, training history, certificates, and registration to practice in a health care area during the credentialing process. We will assesseach and every documents of yours regarding to get credentialed at among worlds premium Healthcare providers organizations. We believe in growing together for a long run. We will guide you to achieve your utmost desirous services. This is the way we care about our clients and focus on providing excellent services to the customers too.

Credentialing Process Highlights

• Direct source verifications are conducted in line with the requirements of state and federal regulatory bodies, accreditation, and WellCare policies and procedures and include a query to the National Practitioner Data Bank.

• Credentialing is required of physicians, allied health professionals, and ancillary facilities/health care delivery companies that wish to provide network services to WellCare members.

• Site inspections must be conducted satisfactorily in compliance with state, federal, and accrediting criteria.

• After the credentialing process is finished, the provider is notified promptly of the credentialing result.

Credentialing may be conducted directly by WellCare or through a delegated credentialing institution approved by WellCare. If credentialing is transferred to an external agency, the agency must adhere WellCare’s criteria to ensure that the selected entity’s credentialing skills clearly match federal and state accreditation specifications (where suitable) and WellCare terms.

Baseline Criteria

The following are the minimum eligibility requirements for practitioners to join a provider network:

• License to Practice

To practice, providers must possess a current, valid, and unrestricted license.

• DEA Certificates

Practitioners must carry a current valid DEA Certificate (as applicable to practitioner specialty) as well as a current Controlled Dangerous Substance (CDS) or Controlled Substance Registration (CSR) certificate if applicable to the state where services are performed (applicable for M.D., D.O., D.P.M., D.D.S., D.M.D.).

• Work History

Practitioners must demonstrate a minimum of five years of relevant work experience as a health professional.

• Board Certification

Providers must be Board Certified in the specialty they practice as a WellCare practitioner, or have verifiable educational/training from an accredited training institution in the specialization needed.

• Hospital Admitting Privileges

Specialist practitioners must have hospital admitting privileges at a hospital that participates in WellCare (as applicable to specialty). Primary care providers may have hospital admitting privileges or may engage into a formal arrangement for member admission with another WellCareparticipating Provider who has admitting privileges at a WellCare-participating hospital.

• Liability Insurance

Unless otherwise approved in writing by WellCare, all WellCare providers (all disciplines) are obliged to carry and maintain professional liability insurance.

• Site Inspection Evaluation

Site Inspection Evaluations (SIEs) are carried out in compliance with federal, state, and accreditation regulations. Performance criteria and thresholds for quality, safety, and accessibility were set with a focus on quality, safety, and accessibility.

• Office site guidelines

• Physical convenience

• Physical appearance

• Sufficiency of the waiting room and examination room space

• Medical/treatment record-keeping measures

SIEs are administered for:
• Unaccredited facilities

• State-specific initial credentialing demands

• State-specific re-credentialing conditions

• When a grievance is secured relative to office place criteria

Re-credentialing

Re-credentialing is required at least once every 36 months in acquiescence with administrative, accreditation, and WellCare policy and plan.

Verification of Application Accepted.

Any absent documentation or employment information will be demanded. If any critical document or information is discovered to be missed during the process, wewill inform the user of the application’s abandonment. Constant updates on an application’s situation, including any impediments you’ll receive at any time.

Contact US

WellCare Credentialing Phone number
Furthermore, any colleague, health care professional, or business partner with suggestions or comments on maintaining ethical behavior or identifying and preventing fraudulent or illegal misbehavior can contact the Ethics Office or call the Helpline 1-800-960-2530 for assistance (TTY 711). To learn more about applying for health insurance, such as Child Health Plus and Medicaid, go here Monday – Friday, 8 a.m. to 6 p.m.

WellCare Enrollment Application
You will be directed to apply online using all of your established credentials. Every entity you enter will be verified and cross-checked. It contains a number of identifying pre-requisite alternatives for marking and proving your credibility. As a result, they will verify all of your information and keep you updated on the status of your ongoing procedures and progress.

Download, print and complete our enrollment form. Mail it to WellCare at P.O. Box 31392 Tampa, FL 33631-3392.

WellCare Enrollment Email
Medicare beneficiaries may also enroll in WellCare through the CMS Medicare Online Enrollment Center located at www.medicare.gov

The above-mentioned email address and phone number can also be used to confirm eligibility status, benefits, and common questions.