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Medicare PPO Provider Billing Awareness

March 8, 2022

Dear Provider,
Wellcare is proud to offer a comprehensive selection of Medicare Advantage plans in your area, including our Preferred Provider Organization plan (PPO). With the Wellcare Medicare Advantage PPO plan, members enjoy the freedom to receive healthcare services from Medicare providers of their choice. As an eligible Medicare provider, Wellcare reimburses you at 100% of the Medicare allowable rate for all plan-covered, medically necessary services for our PPO members – whether you are contracted with us or not.

Increased Flexibility
The Wellcare Medicare Advantage PPO plan offers members flexibility as they navigate their care journeys. PPO members don’t need a referral from a primary care physician for specialist or hospital visits. However, using providers in Wellcare’s network may cost less than choosing one that is out-of-network. Medicare providers who do not contract with Wellcare are under no obligation to treat our members, except in emergency situations.

In addition, the Wellcare Medicare Advantage PPO plan:

  • Offers a simple copayment for doctor visits, hospital stays and many other healthcare services, making healthcare costs more predictable
  • Gives members Medicare Parts A, B, and D coverage as well as vision, dental, and hearing benefits not covered by Original Medicare
  • Covers all Original Medicare services and follows Original Medicare’s coverage rules
  • Only covers medically necessary services rendered by providers who are eligible to participate in Medicare

Billing for Services
If you provide services to a Wellcare PPO member, whether you are in- or out-of-network, we make it easy to seek prior authorizations and submit claims. Please reference the table below for the web links and phone numbers to do so. Referrals or authorizations to see out-of-network providers are not required, however they are highly encouraged.

Wellcare of North Carolina Payer ID:

  • Offers Wellcare 5 digit Payer ID-14163
  • Wellcare (Change Healthcare) Professional- 1844
  • Wellcare (Change Healthcare) Institutional- 8551

Secure Provider Portal: Wellcare Provider Portal
Prior Authorization Form: Prior Authorization Form
Prior Authorization Phone Number: 1-855-538-0454
Prior Authorization Fax (Medical) 1-833-981-4176
Prior Authorization Fax (Behavioral Health):  Inpatient: 1-833-981-4182     Outpatient: 1-833-981-4183
Claims Form: WellCare Claims Form

Out-of-network providers should bill Wellcare first. However, if the member has already paid, we will reimburse the member for our share of the cost for covered services.

Thank you for being a trusted health partner for our PPO members, we appreciate your commitment to improving the health of our communities. If you have any questions about the Wellcare Medicare Advantage PPO plan, please contact Provider Services at 1-855-538-0454 for assistance.



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