January 26, 2021
Dear Provider,
Periodically, WellCare of North Carolina will review its compensation schedule to ensure that it is aligned with current market conditions, including, but not limited to, provider type, geographical locale, and providers in the same geographic region. WellCare of North Carolina conducted a review of the behavioral health compensation schedule and found that the current reimbursement language is not aligned with WellCare of North Carolina’s reimbursement model. Your compensation page currently reads as follows:
Compensation: Fee for service compensation for professional Covered Services provided to Members shall be the lesser of the Provider’s usual and customary billed charges or the following, less Member Expenses: 100 percent of the North Carolina Medicaid physician fee schedule published on the Department’s website on the date the Covered Services are rendered.
At this time, there is no behavioral health fee schedule for North Carolina. As a result of this finding, WellCare of North Carolina will be updating the behavioral health compensation language so that it is consistent with the actual reimbursement model for behavioral health providers. Attached you will find an amendment to your existing contract that clarifies the new language being used. The new compensation page will read as follows:
Compensation: Fee for service compensation for professional Covered Services provided to Members shall be reimbursed as follows: 100 percent of the WellCare behavioral health fee schedule to be reimbursed on the date the Covered Services are rendered.
This language change will render no changes to your current reimbursement schedule. As per your current contract, please reference the language below on notifications:
Health Plan may amend this Agreement upon sixty (60) days’ prior notice to Contracted Provider, and if Contracted Provider objects to the amendment, Contracted Provider shall notify Health Plan of the objection within the sixty (60) day notice period, and Health Plan may terminate this Agreement for convenience in accordance with this Agreement.
Please feel free to reach out to us if there are any further questions or concerns regarding this matter. The preferred individuals to contact are:
Jason A. Young
Senior Manager, New Business Network Development
Cell: 917-471-0301
Claudia Phillips
Contract Negotiator III
Cell: 312-833-2748
Sincerely,
WellCare of North Carolina
