22-190m It's Easy to Request Authorizations and Submit Claims for Medicare Advantage PPO Members

Date: 02/28/22

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

New Medicare PPO plan offered in Amador and Sutter counties

The Wellcare No Premium Open (PPO) plan launched on January 1, 2022. Members can receive professional, institutional and ancillary services through Wellcare By Health Net’s (Health Net’s) direct network of participating fee-for-service providers.

Did you get the news

Information about how this affects you and a list of help with common administrative processes were distributed in provider update 21-759, Introducing Wellcare by Health Net’s New Medicare PPO, on October 27, 2021.

The update included topics about:

• Medical management and prior authorization requests.
• Referrals.
• Claims submission.
• Eligibility

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the Provider Services Center within 60 days at 800-929-9224.