WellCare of North Carolina Monthly Provider Email - June 2024 Edition

Contracting Team Staffing Updates:

We truly value your partnership and are continuously striving to improve your experience. To better serve our Provider community, we have restructured our Contracting Team. We are excited to share these changes and introduce our leadership team.

Effective January 2024, we have formed a dedicated hospital-specific contracting team, led by Allea Parker, Senior Manager of Hospital/Ancillary Contracting. Latonya Fletcher, Manager of Professional Contracting, will oversee all Professional Contracting, including large group practices and Clinically Integrated Networks. Each team is supported by dedicated contracting representatives available to serve providers across all regions and for all programs/products.

If you have any questions regarding your contract or wish to discuss contract terms, please email our team at sm_prosprovnc@wellcare.com. 

For all email inquiries, please include the following information:

• Legal Entity Name
• Tax ID
• Reason for Inquiry
• Point of Contact Name/Phone/Email

We look forward to continuing our partnership with you in 2024!

Extended Supplies of Medication Under NC Medicaid:

We would like to remind our providers that Medicaid beneficiaries, including our WellCare of North Carolina members, are eligible to obtain a 90-day supply of non-controlled, maintenance medications if the prescriber issues a prescription for that duration.

An exception to this is oral birth control medications, which can be dispensed as a full 12-month supply if prescribed accordingly. Please note that certain medications, such as short-term antibiotics and topical steroids, are typically not eligible for a 90-day supply.

Prescribing a 90-day supply for your patients not only offers convenience but also saves them money, as only one copay (if applicable) is charged for the entire 90-day supply.

Thank you for your attention to this matter and for your continued commitment to patient care.

Utilization Management (UM) Updates:

Provider Weekly Meeting:

We continue to offer support for Utilization Management (UM) related issues through our weekly Provider Weekly Meeting.

Meeting Details:

• Name: Provider Weekly Meeting
• Time: Thursdays at 1:30 PM EST (for 30 minutes)
• Format: Informal, problem-oriented discussion

There is no formal sign-up process. If you need an invite, please contact Terresa Thigpen.

Overview:

The Provider Weekly Meeting is designed to address concurrent review or prior authorization issues related to specific cases. Providers are encouraged to email specific case details to Terresa Thigpen and Christina Stewart for follow-up and resolution.

Common topics include:

• Questions about medical necessity
  criteria
• Issues with receiving decisions on authorizations
• General UM process questions

We also handle Medicare, appeals, or claims-related questions by directing providers to the appropriate department for assistance. We look forward to your participation.