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
Pay To Info: Name and Address
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
- 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
Accreditation(s);

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

What’s next?

You will be emailed a Case # for your request.
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