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How to Add Facilities to Existing Contracts

These instructions will help you add facilities to an existing contract.

Step 1

Please complete the application (links below) that applies to your facility.

Note

  • The application must be signed within the past 90 days.
  • Please make sure the attached W-9 tax form has been signed within the past 12 months.

Step 2

Draft a letter to WellCare of KY on company letterhead with the following information:

  • Physical address where services are performed
  • Billing address where services are performed
  • That location’s main phone number
  • Whether the location should be listed in the health plan directory

If the location should be listed in the health plan directory:

  • Specify all health plan products the location should be added to. Note: An existing participating contract is required for the requested product.
  • Product examples:
    • Wellcare Medicare
    • Wellcare of KY
    • Ambetter Health Insurance Marketplace product

Step 3

Does the facility need to add practitioners to this group/location?

If the answer is yes, please download and complete the LOAP/Practitioner Roster Form (XLS). Please ensure that all headers marked in yellow are completed. Any missing, required information will delay the enrollment and/or credentialing process.

Step 4

Prepare the following email with “Facility, Ancillary or BH Add” in the subject line and attach these documents:

  • Credentialing application - CVO Credentialing Facility Form (PDF)
  • Disclosure of Ownership - Facilities (PDF)
    • Note: Include one document per Taxpayer ID
  • Copy of Certificate of Insurance (COI); include dates of group liability coverage
    • Note: The expiration date must not be within the next 90 days of submission
  • W-9 Tax Form
  • Any necessary supporting documents referenced in the credentialing application

Send the email, letter and attachments to: ky_providercorrection@wellcare.com

What’s next?

  • You should receive an automated email acknowledging your request from ky_providercorrections@wellcare.com
  • Once the credentialing process is completed, you will be emailed a confirmation, the approval letter and the effective date.
  • We will reach out if we have questions about your submission.