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Provider Hardship Payment Request

For various reasons, such as claims payment issues, growth, etc., WellCare of North Carolina (WellCare) may have a need to provide hardship funds to providers to help them continue to provide high-quality services to WellCare members for situations that are out of a providers control.

The WellCare Chief Financial Officer (CFO), along with other appropriate WellCare personnel, shall negotiate the terms of the hardship, including the structure, which may be in the form of cash hardship repayable in cash or an advance against future claim payments for the WellCare members who use their facilities, and the repayment terms. Repayment timeframe should, generally, not exceed six months.

Hardship Qualifications

Hardship payments are meant to be a short-term measure to address issues that are beyond a providers control and are used in circumstances that cannot be resolved through engagement with a provider to immediately address any claims adjudication issues. In order for a provider to qualify for a hardship advancement the provider must meet the following criteria:

  • Provider must demonstrate material need for hardship.
  • Provider claims payment delays are not related to claims submission errors that are within their control.

Initiation and Approval

All Provider advances are initiated by the provider through the WellCare Provider Relations team. Any advancement request will be sent to the WellCare CFO to determine if the provider has met the hardship eligibility requirements. A Hardship Agreement is required and must be fully executed prior to final approval and payment initiation. Hardship resolution is reliant on providers to demonstrate need at time of request, promptly respond with documentation when additional details are required, and execute the required Hardship Agreement. Funds disbursement cannot occur until hardship eligibility has been approved and Hardship Agreement has been executed.

Requesting an Advance

Providers needing to request an advance will need to complete the Provider Hardship Payment Request form and email all supporting documentation for the request to NCProviderRelations@WellCare.com. Upon receipt of the request, a provider relations representative will be in contact with the provider to answer any questions about the request and facilitate the next steps in the process.