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Provider : Resources


Authorization Look-Up Tool

Search quickly and easily by CPT code.

 

Provider Manualpdf 
Detailed health plan information on important topics such as coverage procedures and policies. 

 

Quick Reference Guidepdf
Contains key phone numbers and information on claims, appeals and more.

 

Forms

Find forms for appeals, authorizations, behavioral health and more.
 

Behavioral Health
Behavioral health services transitioned from Magellan to the Harmony Behavioral Health Integrated Program. 

 

CareCore National
Harmony currently collaborates with CareCore National to provide prior authorization for advanced radiology, cardiology, sleep management and pain management requests. On August 18, 2014, our partnership expanded to include certain Molecular and Genetic Laboratory Tests, Radiation Therapy, and Outpatient Occupational and Physical Therapy.

 

Claims Updates

Get updates about our processes and ensure your claim is handled efficiently.

 

Clinical Coverage Guidelines 
Evidence-based guidelines detailing the medical necessity of procedures or technologies. Note: Please check the Position Statement in each CCG to determine coverage determination for your state/market.
 

Clinical Practice Guidelines 
Best-practice recommendations based on available clinical outcome and scientific evidence. 

 

Coordination of Benefits
Coordination of Benefits (COB) claims are essential to adjudicating claims correctly. WellCare encourages providers to submit COB claims electronically
 

EFT/ERA

WellCare is pleased to offer providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. Find out why it pays to enroll in these beneficial programs.

 

ICD-10 Compliance
Harmony will be compliant with the Centers for Medicare & Medicaid Services (CMS) rule for ICD-10 readiness beginning Oct. 1, 2015. We have compiled important information and Frequently Asked Questions for providers.

 

Job Aids

 Helpful documents to assist providers as they care for members.

 

Newsletters
Get recent information about pharmaceuticals, cost, quality of care and more.

 

Training and Education

Educational resources regarding initiatives that require specific actions by providers.  You must log in to access required training. Register now.

Last modified: 04/13/2015
 

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