Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. We are simplifying Medicare so you can choose and use an affordable local plan that will.

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Welcome to Wellcare By Allwells new Medicare Advantage website. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. NM Medicaid benefits may be limited to payment of Medicare premiums for some members.Įvery year, Medicare evaluates plans based on a 5-star rating system. Medicaid services are funded in part by the state of New Mexico. 500 to 1,000 coverage limit per year for hearing aids (dollar coverage dependent upon service area) 1 hearing aid every year. Others have been described throughout the body of this manual. Some of these requirements are found in your provider agreement. New Mexico (NM) Dual Eligible Special Needs Plan (D-SNP) Members: As a Wellcare by Allwell D-SNP member, you have coverage from both Medicare and Medicaid. MEDICARE REGULATORY REQUIREMENTS As a Medicare contracted provider, you are required to follow a number of Medicare regulations and CMS requirements. Providers must cooperate with Allwell procedures for handling grievances, appeals, and expedited appeals. Providers will cooperate with Allwell in disclosing quality and performance indicators to CMS. Enrollment in our plans depends on contract renewal. Providers must comply with any Allwell medical policies, QI programs and medical management procedures. Our D-SNP plans have a contract with the state Medicaid program. Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. requirements may be amended to comply with federal and state regulations as necessary. Prior Authorization, Step Therapy, & Quantity Limitations.No reimbursement will be made for claims received beyond this date. Coverage Determinations and Redeterminations The Medicare timely filing requirement is one calendar year from the date of service this includes resubmission of corrected claims that were not able to be processed.

Allwell timely filing limit