In Wellcare's continuous efforts to ensure members are assigned the correct provider upon enrollment, here are some best practices for you to keep in mind when assisting your members. Following these tips to select the correct provider during the enrollment process can increase member satisfaction, ensure timely access to the member’s Primary Care Provider(PCP), and minimize member abrasion.
Ensure that the correct Provider Identifier has been entered in the enrollment applications. Please see the table below for Provider Identifiers according to health plans:
Verify the contract status of the provider (PCP/Specialist) based on the selected plan, as the provider might not be in-network with all Wellcare plans in the area.
Ensure that the provider has a Primary Care Provider (PCP) indicator to be assigned as the member’s PCP on the application. To avoid auto-assignment and member abrasion, do not assign a provider without a PCP indicator.
A specific PCP may not be in-network with all plans within the area. You must certify that the PCP is in-network with the plan selected for enrollment.
If determined a provider is not in-network, explain beneficiary options.
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