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Wellcare Medicare and PDP is getting a new look! Be on the lookout for changes in the coming months and know you can still count on the great coverage you’ve come to expect. Meet the New Wellcare. ×

Overview & Resources

WellCare of Georgia 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.

Important Benefit Information

WellCare provides certain benefits and services specified by federal requirements for health plans administering to Medicaid members.

Medical Expense Initiative

In 2016, edits will be derived directly from the state and national Medicaid editing guidelines. This will save money on vendor fees and additional costs each year. To learn more, please review the National and State-level Medicaid rules.

Electronic Health Records (EHR) Incentive Programs

CMS hosts regular webinars to educate providers on topics related to EHR Incentive Programs. If you use EHR, are interested in EHR capabilities, or want to learn how your practice can benefit, please visit the CMS website for more information.

Resources


Get detailed health plan information on important topics such as coverage procedures and policies.

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

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

Online Tools for WellCare Providers

Guidelines for submitting HEDIS Flat Files, ESD, and Active DX codes.

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), has announced $20 billion in new funding that is available for distribution through Phase 3 of the Provider Relief Fund (PRF).

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

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

Find the Hospital Services Specialist assignments in this network.

The Early and Periodic, Screening, Diagnostic and Treatment (EPSDT) benefit is Medicaid’s federally mandated comprehensive array of preventive, diagnostic, and treatment services for individuals younger than 21.

We are changing our electric breast pump benefit to ensure we meet the Georgia Department of Community Health’s (DCH) guidelines.

PCP Appointment Scheduling Guidelines

Specialist Appointment Scheduling Guidelines

Behavioral Health Appointment Scheduling Guidelines

ProgenyHealth Frequenetly Asked Questions

METS takes a unique approach to member care. We partner with the provider and member to ensure that the member achieves the ultimate level of recovery and resiliency.

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Last Updated On: 5/3/2021