Providers can also view examples of member ID cards below. My Health Pays Program What is the My Health Pays Program? Login Here. Must submit a consent form signed by members parent/guardian, verbally pledge to lose weight within 30 days and complete six sessions within six months. Download the free version of Adobe Reader. Your child can earn rewards while participating in these programs. Any information we provide is limited to those plans we do offer in your area. Drug List (Formulary) and Other Documents. The My Health Pays Program is meant to promote healthy behaviors. Get an annual flu shot today. Go to MyCarePlus to access your CarePlus Rewards program online, through Sharecare. The way it works is simple: complete an eligible activity and get rewarded with a gift card. Sunshine Health offers many convenient and secure tools to assist providers. Members impacted by the program transition were mailed a . You are encouraged to review the My Wellcare Rewards Frequently Asked Questions (FAQ) document for additional information on this topic. In mid-September, Staywell and CMS members will receive new Member ID cards in the mail. You can place your order in a few different ways. You will need Adobe Reader to open PDFs on this site. Getting recommended wellness checks for your child, Working with your childs providers to manage illness (like diabetes), Participating and completing activities within the Smoking Cessation, Weight Loss or Substance Use Disorder programs, Well-child and adolescent preventive check-up visits, Limited doctors office hours and appointments due to COVID-19, Care Managers and Patient Care Advocates educate members on how to complete programs, Quality Practice Advisors educate providers about the programs and ask them to help members complete healthy behaviors, Members no longer needing to complete an attestation to receive rewards, Quality Practice Advisors educate providers about the programs and ask them to help members complete healthy behaviors, Lack of knowledge about needing to complete attestations for rewards, Knowledge deficit about needing to complete an attestation before receipt of reward, Provider office hour and appointment limitations due to the COVID-19 pandemic, Member and parent/caregiver hesitation regarding seeking preventive care due to fear of COVID-19 exposure, Care Managers and Patient Care Advocates educate and encourage members who meet the criteria to enroll and complete programs, Quality Practice Advisors educate providers about the reward programs and seek their partnership in engaging and encouraging members to complete healthy behaviors. Below are key features of the new program. Clinical & Payment Policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or by payment rules. LEARN HOW TO PROTECT YOURSELF. Thanks for signing up! Member benefits are not changing. Medicaid-enrolled provider types that are eligible to provide the vaccine (must have a Medicaid ID) include: physicians, extenders, pharmacies (via pharmacists), Federally Qualified Health Centers, rural health clinics and county health departments. Beginning July 1, 2021, the Healthy Rewards program replaced the My Health Pays rewards program previously available to Allwell Medicare Advantage members across all states. We encourage you to take advantage of this easy-to-use feature. If providers are not in agreement with the determination of a previously disputed claim issue, inquiries should be directed to our Operations Account Resolution (OAR) team [email protected]. If needed, please update to the correct address. The team can help solve problems Monday through Friday between 8 a.m. and 8 p.m. Eastern. The health plan suggests utilizing the prior authorization check tool on our website to verify if an authorization is required: For questions or concerns, please contact your Provider Engagement Administrator. Visit ahca.myflorida.com/Medicaid/Prescribed_Drug/pharm_thera/ fmpdl.shtml to view the current Staywell PDL and pharmacy updates. PLEASE NOTE: These specialty types would need to submit all claims through theHHAX portal: Use theFind MyProvider Engagement Administrator tool. YourProvider Engagement Administrator will be specially trained to understand the nuances and needs of your practice. It includes activities that can help your child live a healthier life. This is a new program that encompasses all former member reward programs for Legacy WellCare and Legacy Centene Medicare Advantage members. Members do not need to take any action. If you work with a vendor for Sunshine Health, you will continue to work with that vendor. If your child leaves the plan for more than 180 days, your child may not receive the reward. For now please continue to treat members from each health plan as you do under your current contract. Questions and Answers Local DSS Medicaid Letters (Notices) Did You Lose Your Medicaid Coverage? Password: Forgot User Name or Password? Limitations, co-payments and restrictions may apply. Well let you know if these will be in person or online. In late-July/August, Staywell, Sunshine Health and Childrens Medical Services Health Plan members received letters in the mail telling them of the integration, effective October 1, 2021. with instant, one-stop shopping. As we work to combine the best of both companies, we expect the transition period to last for approximately 18-24 months. Please follow current processes until further notice. Being healthy means taking care of the body, mind and spirit together. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Including an annual wellness visit, flu shot and many more services. Remember, members ID cards should continue to drive the process you adhere to when you call for eligibility or have claims questions. Wellcare focuses on government-sponsored health care programs like Medicare. Please remember that rewards cannot be transferred. Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. And your child can earn rewards for completing them!*. We are taking this step now to provide you with more streamlined and efficient service. Every year, Medicare evaluates plans based on a 5-star rating system. Our goal is to build a best in classProvider Engagement team to meet your needs. For now, incentive programs will remain separate. . We love meeting new people! 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. The annual flu vaccine helps prevent the flu. WellCare of Florida: Contact your Provider Relations representative, or Provider Services at 1-866-334-7927. We are committed to keeping you up to date on changes before we make them. Complete three coaching sessions with a Care Manager in three months. Having one administrator will also streamline communications, helping us align accountability, eliminate duplications and provide a consistent message. As part of our ongoing integration efforts to combine the best of both Sunshine Health and WellCare health plans, we have reviewed policies and processes regarding prior authorization. We will let you know in advance when that changes. Home For Providers For Brokers Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. We welcome Brokers who share our commitment to compliance and member satisfaction. Complete both HbA1c test and retinopathy screening (dilated eye exam) once in the calendar year. During the transition period, each contract will continue to preserve its rates and serve the same membership it has always served. Create an online account, search for vendors and get discount offers to use at your convenience. The My Health Pays Program is meant to promote healthy behaviors. Member Sign-In * Username Username * Password Choosing an FMO to work with is not just about having access to top insurance products and commissions, its about finding a one-on-one agent service that is prepared to meet your needs. Theres no limit! This tool helps WellCare of Florida members find a provider, physician, specialist, hospital or pharmacy. FLORIDA Healthcare done well. ABA authorizations for CMS Title 21 members should be sent to the health plan for further processing. Plan enrollees are responsible for all costs. Dear Provider, Meridian, MeridianComplete (Medicare-Medicaid Plan), Ambetter from Meridian, and Wellcare are pleased to announce our 2022 Provider Incentive Programs, effective January 1, 2022. Not yet. Please include the legal name, Tax ID and NPI and a member of our Contracting team will respond within 2-5 business days. This resource is available to assist in initially answering questions, researching issues, and providing messages to our Case Managers or other departments dependent on the need. These manuals remain available to you on the internet at the following websites: In addition, members ID cards should continue to drive the process you adhere to when you call for eligibility or have claims questions. As a healthcare provider, you will play an integral role in the COVID-19 vaccine process. Registration is free and its easy. Thanks for being a member! Register Here. The benefit information provided is a brief summary, not a complete description of benefits. This list will be updated as additional vaccines become available. However, members may self-refer for all services, including referrals to specialists and behavioral health providers. Contact us at [email protected] or 844-5-FITBIT (844-534-8248) for assistance with your order. The important thing to know is that members do not need to take any action. They automatically become Sunshine Health members October 1, 2021. Stay tuned to this webpage where you can find all the integration information in one place. You will need Adobe Reader to open PDFs on this site. Call Provider Services at 1-844-477-8313. Once the My Wellcare Rewards portal is live, members can self-attest to any HCAs performed between 01/01/22 and the program go-live date. Enrollment in Case Management and signed consent form by members parent/guardian are required. Complete one postpartum follow-up visit 7 to 84 days after delivery. We will continue to operate in the same way, offer the same services, cover the same members and honor the same provider contracts, as we have in the past. And your child can earn rewards for completing them! Sunshine Health and WellCare of Florida will continue to be separate legal entities and operate as separate plans pursuant to our respective contracts with AHCA and other government agencies. Earn rewards for attending an outpatient follow up appointment with a behavioral health provider within seven days after discharge from an inpatient facility. The benefit information provided is a brief summary, not a complete description of benefits. Please assure your Staywell patients they will keep the same great benefits they have now, plus get even more through Sunshine Health. To register for an upcoming Town Hall or watch a recording of a previous Town Hall, please visit our Provider Training web page. You will need Adobe Reader to open PDFs on this site. This is an attestation-based rewards program. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. Sunshine Health and WellCare of Florida will provide advance notice to our providers and members of any future changes to our brands or provider/member materials. Yes, any group/office staff members can attend the training. THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. Medicare Agent Resource Center (M.A.R.C.). OTC4Me Discount Program. Through the Healthy Rewards Program you are eligible for 1 Fitbit Inspire 2 device at no cost to you! Then contact Sunshine Health at 1-844-877-8313 to update your address in our systems. Annual Well Child Visit with a PCP, one per year. Every time you complete eligible healthy actions, you will earn points. Visit theWholeHealthLiving Choices websiteto start! The above Healthy Activities are eligible for rewards. Please visit Provider Resources and select Medical Management to view our Outpatient Authorization forms. Options for initial and ongoing training include live sessions, instructor-led sessions, specialized webinars, and/or self-paced trainings through Relias Learning, an online learning management system. CMS also has published a set of toolkits to help providers swiftly administer the vaccine. Complete 1 dose meningococcal vaccine, 1 dose tetanus, diptheria, pertussis (Tdap) vaccine and 2-3 doses human papillomavirus (HPV) vaccine. NYS EPIC Program Update | Marketing Rule Update And Guidance | NAHU Is Now NABIP. In person: Wellcare members get access to LifeMart at no cost! 2023 Medicare and PDP Compare Plans and Enroll Now. The entire integration process should be seamless to your patients but they will benefit from the extra care and efficiency you receive through this streamlined process. The information below applies to our Medicaid (Sunshine Health and Staywell Medicaid and Long Term Care), Child Welfare Specialty Plan, Serious Mental Illness Plan and Childrens Medical Services Health Plan products. To get started log in to our secure member portal and select LifeMart Discount in the Wellness and Rewards section. Private Duty Nursing, Personal Care, Home Health, Adult Companion Care, Adult Day Health Care, Assistive Care Services, Attendant Care, Companion Care, Homemaker, Intermittent and Skilled Nursing LPN & RN and Respite Care (home). Members enjoy special savings on medical alert systems from LifeStation. Space is limited. Our operational systems for each health plan, including Claims and Provider Services, remain separate. It includes activities that can help your child live a healthier life. The minimum order quantity has not been reached. IMPORTANT UPDATE: New Deeming Period Feature Will Launch July 13th in Centene Workbench! Benefits may vary by carrier and location. This program rewards you for taking small steps that help you live a healthy life. The Florida Department of Healths (DOH) Childrens Medical Services Health Plan in Regions 1 through 11 through a contract with the DOH. More Information Coronavirus (COVID-19) Keep yourself informed about Coronavirus (COVID-19.) WholeHealth Living Choices program is convenient, easy to use, and full of great products and discounts. Age 10 years old and up. Our provider networks are not yet combined. on everything from computers to car rentals, gifts to groceries, electronics to entertainment, and much more. If you have Medicaid coverage, dont risk losing your Medicare Advantage Dual Special Needs Plan (D-SNP) and Medicaid benefits. If you have not yet received communication from Contracting regarding your contract, please email the Contracting team [email protected]. My Wellcare Rewards Program Extra Benefits You May Receive: Preventive Services Preventive Services may be covered at no additional cost to you! During the transition period, Sunshine Health or WellCare of Florida may approach you with a notice of changes to your contract or to offer you a new contract to cover the Florida brands that are now under Centene ownership. At the same time, you increase your practice's quality scores by providing members with the vaccinations, screening visits and medications they need. Decisions about branding and which legal entity will be the surviving entity have not been made. The Childrens Medical Services (CMS) Health Plan believes that health behaviors can lead to improved health outcomes. Wellcare uses cookies. The majority of our contractual notices have been mailed. One of the benefits of being a Wellcare member is our 24-Hour Nurse Advice Line. If there are any changes in the future, we will communicate them to you well in advance. Prior to October 1, 2021, ALFs require authorization under Staywell MMA and do not require authorization under Sunshine Health. You can only purchase one membership at a time. Your cart limit has been reached. WellCare is closely following advancements in the prevention and treatment of COVID-19. Wellcare is offering our members a discount program calledOTC4Me Discount Program. Sunshine Health is a managed care plan with a Florida Medicaid contract. * Rewards cannot be transferred. Providers are encouraged to utilize the Sunshine HealthSecure Provider Portal. They can also provide education and support to help our members set goals and make better lifestyle choices. Sunshine Health operates as Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA), Long Term Care (LTC) and a Child Welfare Specialty Plan (CW) in all regions through a contract with the Agency for Health Care Administration (AHCA). Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World, [email protected], Find MyProvider Engagement Administrator tool, [email protected], [email protected], [email protected], Inpatient facility admissions, inpatient hospice, detox, SNF and Other Post-Acute Care Services, SIPP (Statewide Inpatient Psychiatric Program), Non-medical NEMT transport for CW members, Select Behavioral Health Community - based services, Procedures done in outpatient setting, ambulatory surgical center or office, Family training and counseling for child development, Intensive outpatient therapy Mental Health, Injectable drugs and drugs given by an MD in office setting, IV infusion, Intensive Outpatient Program for Substance Use Disorder, Dental or oral surgical procedures requiring general anesthesia, Behavioral Health Residential outpatient treatment, Applied Behavior Analysis (ABA) Title 21, Mobile crisis assessment and intervention. Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Sunshine Health and WellCare of Florida are diligently working to develop a detailed transition plan to ensure the transition is smooth for enrollees. Health and Wellness; Help Center; 2023 Provider Directories; Providers. The notification is to advise you that at this time, the plans are aligned on which services do and do not require a prior authorization and there are no significant changes. All clearinghouse partners currently active with Sunshine Health are listed under Electronic Transactions. Target timeframe is within one (1) business day of when message is received; however, this is also dependent on the complexity of the issue. Providers can send a secure email to our Contracting team at [email protected]. Providers must report COVID vaccinations in SHOTS. To get started. Age 10 years old and up. Click here to check out the 2024 broker preview for Wellcare! WellCareMedicare products,claims and correspondence proceduresare not changing at this time. Only WellCare of Kentucky Medicaid plan members residing in the same home are counted as part of the household. To get started and view the full list of eligible activities you can be rewarded for completing,* follow the below instructions . Wellcare will be performing maintenance on Saturday, July 15th, from 6 P.M. EDT to 8 A.M. EDT the next day. The webinar dates will be listed on our respective websites with instructions on how to attend. We expect use of the program to increase over the next year. Member Eligibility Claims adjustments Authorizations Escalations You can even print your chat history to reference later! Call Provider Services at 1-844-477-8313, Monday through Friday from 8 a.m. to 8 p.m. Eastern, or contact your Provider Engagement Administrator. August 11, 2021. Annual wellness visits are included in your benefits, and are your opportunity to discuss your health concerns and options for care. LTC Case Managers submit authorization requests to our LTC UM Team who reviews, processes and initiates the service authorizations. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. If you have any further questions please contact Provider Services at 1-866-334-7927. If your child is earning the first reward, a My Health Pays Visa Prepaid Card will be mailed to you. My Wellcare Rewards program participation: This program is designed to close care gaps; therefore, it is not a claims-based program. 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