July 18, 2022
Attention Valued Partner,
In our continuous efforts to ensure members are assigned the correct provider upon enrollment, we wanted to share some best practices for you to keep in mind when assisting your members. Following these tips to select the correct provider during the enrollment process can increase member satisfaction, ensure timely access to the member’s Primary Care Provider (PCP), and minimize member abrasion.
Document accurate and complete PCP information on enrollment applications to avoid PCP auto-assignment.
- Ensure that the correct Provider Identifier has been entered in the enrollment applications. Please see the table below for Provider Identifiers according to health plans:
- Verify the contract status of the provider (PCP/Specialist) based on the selected plan, as the provider might not be in-network with all Wellcare plans in the area.
- Ensure that the provider has a Primary Care Provider (PCP) indicator to be assigned as the member’s PCP on the application. To avoid auto-assignment and member abrasion, do not assign a provider without a PCP indicator.
Note: On the Wellcare website (www.wellcare.com), providers who qualify as PCPs can be identified by the indicator Primary Care Provider: Yes.
Ensure the Provider is In-Network
A specific PCP may not be in-network with all plans within the area. You must certify that the PCP is in-network with the plan selected for enrollment.
- PCPs may be looked up through the Ascend Web/Mobile Application Provider Lookup tool or through the health plan website.
- If using an alternate enrollment platform, use the provider search tool built into its system. If unsure about the enrollment tool being used, default to the plan website’s provider search tool to verify the provider’s network status with the plan selected for enrollment.
If determined a provider is not in-network, explain beneficiary options.
Important notes for the following plan types:
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Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881