With updated information, we can download the NPPES database and compare the provider data to the information in our existing provider directory to verify its accuracy. If the NPPES database is kept up to date by providers, our organization can rely on it as a primary data resource for our provider directories, instead of calling your office for this information. By using NPPES, we can decrease the frequency by which we contact you for updated directory information and provide more reliable information to Medicare beneficiaries. Centers for Medicare & Medicaid Services (CMS) is also encouraging Medicare Advantage Organizations to use NPPES as a resource for our online provider directories. As you may know, providers are legally required to keep their NPPES data current. If you have questions regarding the information contained in this update, contact 86.Īs a valued provider partner, we’d like to remind you to review your National Provider Identifier (NPI) data in National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure that accurate provider data is displayed. Approval letters include information on steps the member should follow to activate supplemental member benefits. Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days.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.Submit an attestation form through indicating your patient meets the eligibility requirements.Follow the steps on to evaluate your patient against the eligibility requirements outlined on.Once appointment is made follow the steps below: Members are required to schedule an office visit with their doctor or participating physician group for evaluation. Steps to determine eligibility, submit attestations and activate benefits 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.Įffective January 1, 2023, you can check eligibility requirements and submit attestations on behalf of members online at
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