Reference Guide for WellCare Medicare Advantage

EFFECTIVE December 1, 2021, HNS' contract with Absolute Total Care (ATC) will include WellCare Medicare Advantage (MA) plan products.

Medicare Advantage plans are offered by various private companies that have been approved by Medicare.

Individuals that join a Medicare Advantage plan still have Medicare, but coverage is from the plan and not original Medicare.

WellCare MA products cover those same chiropractic services covered by original Medicare. Just as with Medicare, please be sure to include the AT modifier, as applicable.

This WellCare MA Quick Reference Guide provides information specific to WellCare MA concerning, claims, members, and policies.

General Information

Eligibility/Benefits

Prior Authorization

PCP Referral

Copayments

WellCare ID Cards

Claims Submission

Claims Inquiries

Provider Relations

General Information

Please do not send claims directly to WellCare. All WellCare claims must be sent to HNS.

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating WellCare provider through HNS, and our instructions for filing claims supersede information given to you by WellCare Representatives!

If you have any questions about WellCare, please email your HNS Service Representative before calling WellCare. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

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Eligibility/Benefits

Be sure to ALWAYS verify eligibility for each WellCare member!

To verify eligibility and benefits, refer to the telephone number on the member's identification card.

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Eligibility/Benefits Form.

ATC/WellCare has attached the HNS EIN to all HNS providers, so you MUST use the HNS TAX ID number (56-1971088) when calling to verify benefits. (If you use your own EIN when verifying eligibility and benefits, you will be told that you are not listed as a participating provider.)

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Prior Authorization

Prior authorization is NOT required for chiropractic manipulation for WellCare members.

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Referral System

Referrals from the members' Primary Care Providers are not required.

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Copayments

WellCare copayments will vary by MA plan product and county in which the product is offered. The members' ID cards will have the applicable specialty copays printed on them.

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WellCare ID Cards

All WellCare claims must be submitted to HNS. Please remember to obtain a copy of the front and back of the insurance card and maintain this in the member's health care record.

If you are uncertain about where to file the claim, please email your HNS Service Representative a clear, legible copy of the member ID card and we will promptly respond back to you with an answer. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

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Claims Submission

Please do not send claims directly to WellCare. All WellCare claims must be sent to HNS. (Please ignore the billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits.) All primary claims must be submitted electronically to HNS.

If necessary to submit a claim via paper (primary, secondary, corrected claims or claims with attachments), WellCare requires: 

• The submission of the original red and white CMS 1500 claim form. Only the standardized red/white form (printed in Flint OCR Red or an exact match) will be accepted.
• That paper claims must be typed. They cannot be handwritten (and cannot include any handwritten words on the claim).

WellCare will deny all paper claims which are not submitted via the red/white CMS 1500 claim form and/or which are handwritten.

Group Number:

While WellCare ID cards will not include a group number, to ensure the correct adjudication of the claim, please enter "WellCare" as the group number in Box 11 of all WellCare claims.

WellCare must also be included in Box 11c on the claim form.

Even when filing the claim electronically, the claim must be identified as a WellCare claim in the address section at the top of the CMS 1500 claim form (HNS/WellCare is the acceptable format).

Example:
HNS/WellCare
PO Box 2368
Cornelius, NC 28031

CLICK HERE for information on filing corrected claims.

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Claims Inquiries

For assistance from HNS on claims status (after 60 days from your billing date), please email your HNS Service Representative and include the provider name, member name, member date of birth, member ID number, the date(s) of service in question, and any pertinent information regarding the issues. We will gladly trace the claim for you and respond back to you within 3 business days.

Resubmit lost/missing claims through HNS.

Refer to the HNS/WellCare Medicare Advantage fee schedule to confirm allowable amounts. All HNS fee schedules are located on the secure portal of the HNS website.

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Provider Relations

Questions relating to your participation in WellCare MA should be emailed to your HNS Service Representative. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

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