At WellCare, we value everything you do to deliver quality care to our members – your patients – and ensuring they have a positive healthcare experience.
Effective March, 4, 2019, WellCare is adopting Milliman Clinical Guidelines (MCG) criteria for Medicaid Inpatient Physical Health (Inpatient Admissions, Post-acute Care, Skilled Nursing Facility, Inpatient Rehabilitation, and Long-term Acute Care). Outpatient Physical Health and Outpatient Behavioral Health services from the current Change Healthcare/McKesson InterQual™ criteria.
MCG Health’s innovative software offers system wide solutions that ensure appropriate and cost-effective care for your patients – our members.
Recent changes in healthcare law require payers to navigate increasingly complex regulations to maintain compliance. Clinical decision support from MCG lets you and WellCare craft care plans by using the latest medical data with those regulations in mind.
In addition, MCG solutions let WellCare and providers share documentation and automate prior authorizations. This cuts administrative costs, which lets you more efficiently improve the member's journey to better health.
More than 80% of the U.S. payer market uses MCG guidelines and software. They help you provide our members with better healthcare experiences – saving time and money. MCG tools can help reduce length of stay in acute and post-acute settings as well as 30-day hospital readmissions, which can improve independent quality ratings (HEDIS®, CMS Stars).
For questions or information regarding WellCare policy and procedures, visit our website at www.wellcare.com/newjersey. You can also contact a Provider Services representative at 1-888-453-2534, Monday through Friday from 8 a.m. to 6 p.m.
Thank you for all you do to provide quality care to our members.
