Provider : Resources

• Provider Manual
  An extension of the Participation Agreement and a resource that provides guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members. This document should be used simultaneously with the Quick Reference Guide and other reference resources.

 

• Provider Quick Reference Guide
  Provides Harmony contact information and authorization guidelines

 

• Provider Forms and Documents
  Template forms and documents for appeals, authorizations, claims, pharmacy services and more.
   
• Clinical Coverage Guidelines (You will be redirected to our corporate website.)
  Evidence-based guidelines detailing the medical necessity of, and sets consistent criteria for coverage of, given procedures or technologies to ensure greater consistency and efficiency in clinical decision making.
   
• Clinical Practice Guidelines (You will be redirected to our corporate website.)
  Best-practice guidelines used to guide efforts in improving the quality of care in our membership.  CPGs are based on available clinical outcome and scientific evidence-based content developed by expert professional and clinical society recommendations.

 

• Provider Training and Education Materials (You will be redirected to our corporate website.)
  Educational resources regarding initiatives that require specific actions by providers. You must log in to access required Provider training.  Click here if you are not a registered user. 

 

• Provider Newsletters
  Quarterly newsletters to provide current information on pharmaceuticals, cost and quality of care, to share tips on how to perform processes more efficiently with the plan, and to highlight recent successes, such as accreditations and quality scores.
   
• Claims Corner
  Provides updates on WellCare's claims processes, ensuring that provider claims are handled efficiently.

 

MO Approval Date: 12/12/2011