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Medicare Providers

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Overview & Resources

Wellcare partners with providers to develop and deliver high-quality, cost-effective health care solutions. We understand that maintaining a healthy community starts with providing care to those who need it most. We are committed to improving the quality of life of our millions of members, who often include some of our nation's most vulnerable populations.

California Provider Resources


IPA, Hospital & Ancillary Medicare Provider Manual

Contains key phone numbers and information on claims, appeals and more.

Details the various tools available to help providers do business with WellCare.

Detailed plan information on important topics relating to vision plan.

Improve CAHPS Results and Patient Experience - A Provider Guide

Guide to using self-service features in the provider portal.

California Dental Plans

How to quickly get in touch with WellCare to get your questions answered.

Make appointments or respond to patients within regulatory standards.

A STAR score is a rating system used by Center for Medicare and Medicaid Services (CMS) to measure how well healthcare plans perform in categories such as quality of care and customer service. Ratings range from 1 STAR (poorest quality) to 5 STARS (highest quality).

24-327: When a member’s PCP is not available for immediate care, knowing the best option to get same-day health care services can save time, travel and unnecessary cost.

Member notification of health care provider/facility leaving network (H5087)

Medicare Provider/Facility Tip Sheets

Follow-Up After Emergency Department Visit For People With High-Risk Multiple Chronic Conditions (FMC)

Hospitalization for Potentially Preventable Complications (HPC)

Follow-Up After Emergency Department Visit For People With High-Risk Multiple Chronic Conditions (FMC) Medicare Beneficiaries

Guidance on Documentation and Coding for Amputation Status, Prosthetics and Artificial Limbs

Guidance on Documentation and Coding for Porphyria, Amyloidosis and Metabolic Syndrome

Guidance on Documentation and Coding for Anorexia Nervosa and Bulimia Nervosa

Guidance on Documentation and Coding for Pancreatitis

Guidance on Documentation and Coding for Cleft Lip and Cleft Palate

Guidance on Documentation and Coding for Premature Newborns and Hemolytic Disease of Newborns

Guidance on Documentation and Coding for Angina and Ischemic Heart Disease

Guidance on Documentation and Coding for Aplastic Anemia

Guidance on Documentation and Coding for Atherosclerosis of theExtremities and Gangrene

Guidance on Documentation and Coding for Lipidoses and Glycogenosis

Guidance on Documentation and Coding for Congenital Metabolic Disorders, Not Elsewhere Classified

Guidance on Documentation and Coding for Muscular Dystrophy

Guidance on Documentation and Coding for Prader-Willi, Patau’s, Edward’s and Autosomal Deletion Syndromes

Guidance on Documentation and Coding for Drug Induced Psychosis

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Last Updated On: 10/24/2024