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Provider Digest | Volume 25

Date: 01/26/22

Updated Inpatient & Post-Acute Care Guidelines for Wellcare Providers

To support increased access to care during the COVID-19 pandemic, Wellcare By Health Net and Wellcare By Trillium Advantage will process all inpatient and post-acute care requests according to the below guidelines through 1/31/22: 

  • Inpatient Admissions: We will allow notification of admission up to 5 days post admission date and complete medical necessity reviews when notification is received.
  • Skilled Nursing Facility Admissions: We will require receiving facilities to notify the health plan of patient admission. And we will accept notification up to five days post-transfer.
  • Skilled Nursing Facilities: We will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.
  • Post-Acute Accommodations for rehab hospitals and Long Term Acute Care hospitals (LTACH): We will relax our requirements related to facility transfers including:
    • We will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 
    • We will not require sending facilities to provide notification of transfer to participating providers. 
    • However, we will require receiving facilities to notify the health plan of patient admission. And we will accept notification up to five days post-transfer.
    • We will continue to conduct medical necessity review.
    • Because we will not have visibility prior to transfer, we request that hospitals utilize our in network post-acute facilities.

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New Payment Policy for Wellcare By Health Net

We continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. Effective 02/15/2022, Wellcare By Health Net will be implementing this new policy:

Policy CP.PP.501: 30 Day Inpatient Readmissions

For more detailed information about payment policies, please refer to our website.

For questions about this or any of our payment policies, please contact our Wellcare Provider Services team at 1-888-445-8913.
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Wellcare Providers: Request to Submit Charts to Datafied

Staring this week, Wellcare By Health Net and Wellcare By Trillium Advantage providers will receive notifications requesting a new list of charts to retrieve and submit to our vendor Datafied for the Wave 2 chart chase for risk adjustment. There are five HIPAA compliant options for submitting charts:

  1. Fax records via secure fax to Datafied: 714-224-0255
  2. Upload records via secure HIPAA compliant portal at https://secure.datafied.com/records
  3. Extract records form your EMR/EHR system
  4. Mail records to Datafied at PO Box 18089, Anaheim, CA 92817-8116.
  5. Request to have a Datafied representative scan the records on site

Thank you for your partnership in this effort. If you have any questions, please contact your Provider Relations Representative.
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Unite Oregon Action: RIPPLE Leadership Series Begins in February

Unite Oregon Action is excited to announce RIPPLE (Refugee, Immigrant, People of Color Power-Building, Leadership & Education), a new leadership series designed to build power for emerging Immigrant, Refugee, Black, Indigenous, People of Color (IR-BIPOC) leaders through political education, advocacy, and organizing skills delivered in a culturally responsive BIPOC-created curriculum.

The RIPPLE program will train IR-BIPOC leaders through a 5-week intensive series culminating in a job fair where graduates can network with political organizations, community-based organizations, campaigns and be connected to job opportunities.

Questions? Contact Gloria Sandoval at Gloria@uniteoregonaction.org or 971-600-1516.

Learn more and register here.