New Easy Order OTC: Its easy to use your $35 per month per household (OTC) benefit. Staywell Health Plan is a Managed Care Plan with a Florida Medicaid contract. Learn more about the pharmacy benefit. This, in turn, inflated the profits of Staywell, Healthease, and WellCare and earned the defendants financial rewards.. New Specialty Pharmacy Provider: AcariaHealth provides Sunshine Healths specialty medications. Services are limited to those circumstances where the childs condition creates a disability and impairment to their physical development. After 120 days, you will need to get services through a Sunshine Health network provider. WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. Our local approach allows us to help members access high-quality, culturally sensitive healthcare services. We highlight the stories of Black Floridians seeking emotional healing and wellness. Pensacola, Tallahassee, Ocala, Jacksonville, New Port Richey, Tampa, Orlando, Fort Myers, West Palm Beach, Lauderhill, Miami. Authorizations. WellCare merged last year with Centene Corp. in a $17.3 billion deal that combined two of the largest players in Floridas Medicaid managed-care system. If applicable, your plan's copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment, along with the associated physician's visit. Avoid close contact with people who are sick. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Provider Services Eligibility Verification, Claims, Utilization Management, Provider Complaints, Risk Management WellCare's Fraud, Waste and Abuse Hotline Florida Medicaid Program Integrity Hotline Nurse Advice Line 1-866-678-8355 1-888-419-3456 In most cases, your care manager and your providers will stay the same. 2023 a Panangimaton iti Therapy a Panagagas, Panangberipika iti Log in ti Elektroniko a Panagbisita, Behavioral Health Toolkit for All Providers, Including Primary Care Physicians. View the new Krames/StayWell Library. By continuing to use our site, you agree to our Privacy Policy and Terms and Conditions. Complete this form to request reimbursement/refund for covered prescription drugs that you paid full price for. Its called My Health Pays. For a complete list of benefits, see your Evidence of Coverage. This document provides additional details about the dental benefits, including a list of services and benefit limits. More Information. The benefit information provided is a brief summary, not a complete description of benefits. Become a Broker. If you dont verify your Medicaid eligibility on time, you will lose your Medicaid and Medicare Dual Special Needs plan benefits. Everyone 6 months of age and older should get a flu vaccine once a year. Take deep breaths, stretch or meditate. Coverage of the coronavirus pandemic on Health News Florida. Forms. Medicare PDP Providers 1-888-550-5252. This form confirms your request for a particular person to act as your representative in connection with a claim. The plan provides a comprehensive system of care centered around each childs unique needs. Wellcare uses cookies. Wellcare will be performing maintenance on Saturday, July 15th, from 6 P.M. EDT to 8 A.M. EDT the next day. Incredibly, reminders are still needed, How Baltimore is trying to keep its people safe from xylazine, Biden to meet Israel's Netanyahu after months of tension, Florida's idea to use radioactive waste in road construction is unsafe, critics say, Remembering Andr Watts, the American pianist who opened doors of possibility, Insurance Regulators Back Tampa-Based Wellcare-Centene Merger, Appeals Court Upholds Convictions Of Ex-WellCare Executives. You will get a new Sunshine Health ID card in the mail in mid to late September 2021. Care and Disease Management Referrals Non-MMA Members 1-866-635-7045 : TTY 711 Fax 1-866-287-3286 As a result, the information was later dismissed by the court following a government motion. Therapeutic class search (drugs grouped by type of condition) - select your drug class. It describes the member cost sharing protections provided under the Inflation Reduction Act (IRA) for certain Part B drugs. We have good news. You will automatically become a Sunshine Health member on Oct. 1, 2021. It's important you take action when the time comes to renew your Medicaid eligibility. A .gov website belongs to an official government organization in the United States. If your pharmacy is not in network, you can keep going to the same pharmacy for 120 days after Oct. 1, 2021. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin . A federal jury in Tampa found four former executives of WellCare Health Plans Inc., a health maintenance organization (HMO) operator, guilty of various charges, including health care fraud, making false statements relating to health care matters and making false statements to a law enforcement officer, announced Acting Assistant Attorney General Mythili Raman of the Justice Departments Criminal Division, U.S. Attorney Robert E. ONeill of the Middle District of Florida and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office. We have good news. How much is a Kel-Tec 9 millimeter pistol? 24-Hour Nurse Advice Line. Staywell Health Plan and Sunshine Health are bringing our health plans together to better serve our members, providers, partners and communities. Call us at 855-888-8326. To confirm if your current therapy provider is a participating provider or if you have any questions regarding therapy services, please contact Member Services at 1-866-796-0530 (TTY 1-800-955-8770). Your Long Term Care plan, Staywell Health Plan, is joining Sunshine Health. Medicare Overview Special Supplemental Benefits for the Chronically Ill - Attestation process for patient eligibility. WellCare . Thaddeus M.S. Bereday later pleaded guilty to a charge involving a false statement. Were excited to welcome you to Sunshine Health! Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World, Unlimited nutritional counseling as recommended by your doctor, Unlimited art therapy as recommended by your doctor, Various medical supplies and equipment, such as hypoallergenic bedding for people with asthma, Unlimited coverage for outpatient hospital services recommended by your doctor, Eligible members with a SafeLink Wireless phone can get additional minutes as needed through the ConnectionsPlus program. Independent Laboratory/Diagnostic Facility. An official website of the United States government. Participant Direction Option (PDO) program: If you participate in the Participant Direction Option, you and your Direct Service Worker (DSW) do not have to do anything different. Sunshine Health and WellCare of Florida will maintain all of the separate AHCA, DOH, Marketplace and CMS Medicare Advantage contracts that we had prior to the transaction closing. On March 2, 2011, a federal grand jury sitting in Tampa returned an indictment charging Farha, Behrens, Kale and Clay with various federal criminal violations related to a scheme to defraud the Florida Medicaid program, from the summer of 2003 through the fall of 2007, by making false and fraudulent statements relating to expenditure information for behavioral health care services. Diagnosed with Medicare-qualifying disabilities such as End-Stage Renal Disease (ESRD), Amyotrophic lateral sclerosis (ALS), a.k.a. As a Sunshine Health member, you get your Medicaid benefits, a large provider network, a 24/7 nurse line, and many extras to help you live a more healthy life, including: During this change period, please keep all scheduled doctor appointments. For example, earn $25 for completing weight loss coaching sessions. Are there strategies for coping with the COVID-19 outbreak? This site has added assessments for wellness and lifestyle improvements. Welvie has broken down your surgery journey into six simple steps that take you from diagnosis to recovery: It pays to know Welvie. 833-910-0117 Members: call the number on the back of your ID card or go to the plan site. Be responsible for a child 18 years of age or younger,or, Have a disability or a family member in your household with a disability,or. At least in part, the case involved allegations that WellCare deceived the state about how much money the company spent on behavioral-health services for Medicaid beneficiaries and did not refund money as required. You can keep getting services that Staywell or your doctor already approved for up to 120 days. As a participating provider, you'll need to understand your responsibilities under Wellcare's compliance program to help ensure the best possible care for our members. This could get loved ones around you sick. This document is an addendum to the 2023 Evidence of Coverage (EOC), Annual Notice of Change (ANOC) and Summary of Benefits (SB). We've made it easy to find everything you need to onboard with us. Don't risk losing your Medicare Dual Special Needs plan and Medicaid benefits. For example, pregnant members earn $20 just by filling out a Notification of Pregnancy form in the first trimester. We have good news. As part of the scheme, the defendants falsely and fraudulently submitted inflated expenditure information in the companys annual reports to AHCA, in order to reduce the WellCare HMOs contractual payback obligations for behavioral health care services. Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the Fall/Winter months. Please complete this form with your provider if you want to change your PCP. Plus, our provider network is growing to give you even more choices. Yes. 202-514-2000. See the full list of rewards. For more information contact the Managed Care Plan. No. You get to keep the same great benefits you enjoy now. 2023 Medicare and PDP Compare Plans and Enroll Now. Browse and select products to be shipped to your home, all from your phone. If you have a care manager, continue working with them. There are three different programs that makeup the Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Program, Long-term Care (LTC) Program, and Dental Program Learn More About MMA and LTC Learn More About Dental We will not share any health information about you that is not allowed by law. It can spread from person to person. If you continue to use this site we will assume that you are happy with it. >>Complete your Attestation today!<<. Providers may experience higher than normal wait times when calling Provider Services so we encourage providers to use the web portal for eligibility, claims submission, etc. The maximum penalty for each of the health care fraud counts is 10 years in prison. You will keep all the benefits you currently have as a Staywell Health Plan Comprehensive Long Term Care member, plus get more benefits from Sunshine Health. You do not need to do anything to start enjoying the new benefits of becoming a Sunshine Health member. No. (TTY users dial 711 .) Please call the facility/provider that provided your first dose from to ask about your vaccine information and verify your second appointment/location. (TTY users dial 711 .) Upper, lower or complete set of dentures, limited to once per the lifetime of the child Orthodontic Services (Braces) Treatment requires Prior Authorization. I don't have their contact information. We will review your request and if . After 120 days, you will need to get your medicines at a Sunshine Health network pharmacy. These new benefits are designed with your health in mind and include: You will become a Sunshine Health member on Oct. 1, 2021. Please continue scheduling your services with your DSW and submitting your timesheets to GT Independence. New Therapy Provider: Your therapy benefits have not changed, but your new therapy benefit administrator will be Health Network One. Please be aware, most Staywell providers are in the Sunshine Health provider network. Its called My Health Pays. The CDC announced on March 8 that fully vaccinated Americans Do not have to wear a mask and distance from other people who are vaccinated in small groups indoors. Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow. Our nurses will give you answers to your medical questions and help you decide whether to see your doctor or go to the emergency room.