Provider Notices are sent when we have specific notices from ODM, CMS or Buckeye operations/policies that you need to know, but can’t wait for the newsletter.
Welcome to the new Wellcare. As a valued Allwell provider, we want to share some exciting changes to our Medicare plans.
See the notice below.
Welcome to the new Wellcare!
As a valued Allwell provider, we want to share some exciting changes to our Medicare plans. We’ve combined multiple brands under the Wellcare name to offer a better range of plans that provide members with affordable access to doctors, nurses, and specialists.
We’re working hard to get rid of the nonsense in health insurance. That’s why we’re offering simplified plans, streamlined benefits, and new ways to save. And as always, Wellcare is committed to working with you to ensure your patients receive the best care.
We know you probably have a few questions, so we want to take a moment to answer them for you.
- Which Medicare brands will become Wellcare? Allwell
- Does this involve all lines of business for these brands?
No, only Medicare. In designated states, some of these brands will continue to exist with Medicaid and Marketplace plans.
- When does the transition begin?
This fall, you will begin to receive materials with the new Wellcare branding. We will offcially transition to Wellcare on January 1, 2022, unless otherwise noted.
Please note, you may see materials with the old branding prior to January 2022.
If you have additional questions, we’re here to help. Contact Provider Services at: 855.766.1851.
Thank you for your partnership with Buckeye Health Plan. In addition to other Buckeye member vaccination initiatives, we are also working with our parent company, Centene, to navigate the COVID-19 pandemic to ensure our members have the support they need in their efforts to get vaccinated. We have recently undertaken an initiative in support of the national goal to vaccinate 70% of eligible Americans by July 4th, and we hope to enlist your support in this work
We are contacting our members across all lines of business for whom we did not have evidence of a COVID-19 vaccine. We asked them to indicate their vaccination status over the phone. We have posted a preliminary roster of your unvaccinated members to our secure provider portal. We will post an updated file when our member outreach is complete
As we work together to keep our members healthy, we are counting on you to help your Buckeye patients get vaccinated, address any concerns they may have about the vaccine, and offer guidance on the best way to find an appropriate vaccine site in your community. The rosters posted in our secure portal include each unvaccinated member’s name and phone number for easy outreach, and we are asking you to contact them and encourage them to get vaccinated.
To navigate to the roster of unvaccinated members, log into the secure portal at Buckeye Provider Home Page. Once in the portal, go to the “Welcome” center on the right-hand side of the screen and click on the “Reports” tab. From there you will be able to find and download date-stamped member roster files.
If you have any questions about this program you may reach Provider Services at 866.296.8731.
May 13, 2021
Behavioral Health Providers
[Applicable to all Medicaid and Medicare Providers]
Thank you for being a valued partner and providing outstanding care to our members, your patients. In our efforts to streamline the prior authorization process and remove some administrative burden, we are implementing the following changes related to behavioral health services:
- Effective 3/15/20 forward, providers are no longer required to obtain a prior authorization for ACT (H0040) and IHBT (H2015) for the first six months of treatment.
- After 6 months of treatment/billed services, a prior authorization will be required for both ACT (H0040) and IHBT (H2015) services. All billed services after 6 months without an authorization will deny.
If you have any questions or concerns about the policy changes above, please outreach your local provider relations team member or contact our provider services team at 866-296-8731.
New Somatus Care Management Program for Patients with CKD/ESRD
[Applicable to Allwell Advantage HMO Providers]
Effective June 1, 2021, Buckeye will partner with Somatus Inc., to establish a care management program for members with end-stage renal disease and chronic kidney disease. Some of your patients may qualify for this program.
Patient benefits include:
- Care management of kidney disease and comorbidities
- Instruction to better understand the condition, treatment options and diet
- Help to transition from hospital to home
- Guidance in transplant options
Social workers can help with transportation, food or other issues that limit the member’s compliance with treatment.
We will be in touch with you about your eligible patients. If you have questions before we contact you, please call Somatus at (855) 851-8354, Monday-Friday from 9 a.m. to 5 p.m. Eastern Time.
Prenatal Risk Assessment Form (PRAF) Overview/Checklist
A complete PRAF helps Moms receive the best support for a healthy pregnancy
As you know, it’s important to ensure pregnant moms maintain Medicaid eligibility throughout pregnancy and during the immediate post-partum period. Buckeye is dedicated to helping our providers with the tools they need to make their job easier. Download our new PRAF Overview/Checklist.
Prior Authorization Changes – Preferred Biosimilar Changes Effective 11-21-2020
On November 21, 2020, the following changes will take effect.
Epoetin alfa-epbx, Retacrit, Q5105 and Q5106 will be the preferred erythropoiesis-stimulating agent (ESA) for new and continuation therapy.
This change effects the following site of care settings: provider-administered, outpatient hospital or ambulatory care center. Please see the announcement for full details.