For Providers

Wellcare by Allwell from MHS provides the tools and support you need to deliver the best quality of care. 

Submit Attestations Online for Chronically Ill Members

Effective January 1, 2023, fax attestations are no longer accepted

Special Supplemental Benefits for Chronically Ill (SSBCI) are offered to Wellcare’s highest-risk members who meet specific criteria for eligibility based on the Centers for Medicare and Medicaid Services (CMS) guidelines. 

Effective January 1, 2023, you can check eligibility requirements and submit attestations on behalf of members online at ssbci.rrd.com.

Steps to determine eligibility, submit attestations and activate benefits

Members are required to schedule an office visit with their doctor or participating physician group for evaluation. Once appointment is made follow the steps below:

1. Visit ssbci.rrd.com.
2. Follow the steps on ssbci.rrd.com to evaluate your patient against the eligibility requirements outlined on ssbci.rrd.com.
3. Submit an attestation form through ssbci.rrd.com indicating your patient meets the eligibility requirements.
4. Submit a claim with the appropriate diagnosis codes from this office visit indicating a member has been diagnosed with one or more qualifying chronic conditions listed on ssbci.rrd.com.
5. Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days. Approval letters include information on steps the member should follow to activate supplemental member benefits. 

If you have questions regarding the information contained in this update, contact your dedicated Provider Relations Representative with the health plan.

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Provider Portal

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Notifications

• COVID-19 Medicare Public Health Emergency Notice (PDF)
• Medicare Prior Authorizations Updates (PDF)
• Point of Care Formulary Information for Providers (PDF)
• Medicare Member Liability Reinstatement Notice (PDF)
• Medicare Billing Updates (PDF)
• Medicare Provider Authorizations Flexibilities (PDF)
• Peer to Peer and Inpatient Authorization Updates (PDF)

Reference Material

• Welcome Letter (PDF)
• Benefits Overview (PDF)
• 2023 Wellcare by Allwell Provider Manual (PDF)
• Medicare Advantage Plan Overview (PDF)
• Quick Reference Guide (PDF)
• Prior Authorization Tip Sheet (PDF)
• Electronic Funds Transfer (EFT) Payspan (PDF)
• Secure Provider Portal (PDF)
• Risk Adjustment Tip Sheet (PDF)
• QMB Billing (PDF)
• QMB Billing Frequently Asked Questions (PDF)
• 2021 Continuity of Care (CoC) Bonus Program (PDF)
• Improve Patient Care and Quality of Life (PDF)
• Medicare Health Outcomes Survey (HOS) (PDF)

Medical Management

• Medicare Part B List – Effective 1/1/2022 (PDF)
• Medicare PA List — Effective 10/1/2023 (PDF)
• Medicare Pre-Auth Tool
• Inpatient Medicare Authorization Form (PDF)
• Outpatient Medicare Authorization Form (PDF)
• Outpatient Treatment Request Form (PDF)
• Outpatient Psychological Testing Authorization Request Form (PDF)
• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• Psychological or Neuropsych Testing Authorization Request Form (PDF)

Provider Education

• Model of Care Training (PDF)
• Jimmo v. Sebelius - Presentation (PDF)
• Jimmo v. Sebelius - Summary of Questions and Responses (PDF)
• QMB Provider Letter (PDF)
• 2019 QMB Training Deck (PDF)
• Click here for Coronavirus Information
• Click here for Billing Guidelines for COVID-19 Vaccine
• Self Study Guide (PDF)

Archived Medicare PA & Part B Drug Lists Section

• Medicare PA Updates Effective 10/1/2021 (PDF)
• Medicare PA List - Effective 1/1/2021 (PDF)
• Medicare Part B Drugs - Effective 1/1/2021 (PDF)
• Medicare PA List - Effective 8/1/2021 (PDF)
• Medicare Part B Drugs - Effective 8/1/2021 (PDF)
• PA List 2021 Part B Apendix -Effective 8/1/2021 (PDF)
• Medicare Step Therapy Part B list - Effective 1/1/2021 (PDF)