FOR NETWORK PROVIDERS

Partner with us.

WelbeHealth brings high-touch medical and social services to frail seniors in underserved communities. We’re looking for partners who share our vision of every human being participating in society through their final days.

WelbeHealth’s PACE Model and Day Centers

SERVICES

Through WelbeHealth’s Program of All-Inclusive Care for the Elderly (PACE), we provide full medical coverage and whole-person care. Our team supports participants 24/7, and includes:

  • Primary and specialist care
  • Transportation to medical appointments
  • Social activities
  • Dental, vision and hearing
  • Prescriptions with home delivery
  • Physical and occupational therapy
  • Mental health support
  • Social work services
  • Nutrition support, in-home services, and more.

DAY CENTERS

At WelbeHealth’s PACE day centers, seniors can take art classes, join exercise groups, and attend special events. The center contains a medical clinic, rehabilitation gym, recreation space, and a separate space for dementia care. Our centers have doctors, therapists, social workers and more, who all specialize in caring for seniors.

SERVICE AREAS AND EXPANSIONS

WelbeHealth is rapidly expanding into new areas. Currently, we have locations in these areas of California:

Long Beach

Pasadena

Stockton

Fresno

Modesto

Resources for the WelbeHealth Provider Network

CREDENTIALING

During the credentialing process, we’ll work with you to verify your qualifications, practice history, certifications and registration to practice in a health care field.

Provider Manual

CONTRACTS

Contracted providers are an essential part of delivering quality care to our members. If you are interested in working with us, please contact John Olivarri.

FAQ

ONBOARDING

WelbeHealth values our provider partnerships and supports the doctor-patient relationship our participants share with you. Superior customer service and provider relations are one of our highest priorities, and that begins with the credentialing, contracting, and onboarding process.

Welcome Packet

The onboarding process will begin with WelbeHealth upon completion of the contracting and credentialing process. In advance of that, please review our Welcome Packet and other links below.

Attestation Form

AUTHORIZATIONS

Authorization requests must be submitted either via the Provider Portal or a completed Authorization Request Form faxed to (209) 729-5854. Use of the Portal will allow quick, direct submissions and status checks on authorizations. When authorization is not required, call WelbeHealth’s Advocate Hub at (650) 336-0300 to schedule the service.

Authorization Request Form
Prior Authorizations List

News & Communications

Read more

WelbeHealth Advocate Hub

Our Advocate Hub offers the following services to providers:

  • Authorizations
  • Benefits coverage validation process
  • Scheduling of visits and transportation

If you have questions, call our provider service line at 650-336-0300 or email our scheduling team at welbehubrequest@welbehealth.com.

For questions or additional support, reach out to your designated provider relations representative.

NORTHERN CA MARKETS

Fresno Market
Emily Savage – Provider Relations Coordinator
providers@welbehealth.com
(650) 336-0300

Stockton / Modesto Market
Sichampou Siphan – Network Associate
providers@welbehealth.com
(650) 336-0300

SOUTHERN CA MARKETS

Long Beach Market
Amanda Barraza – Provider Relations Coordinator
providers@welbehealth.com
(650) 336-0300

Pasadena Market
Beverly Yip – Provider Relations Coordinator
providers@welbehealth.com
(650) 336-0300

POST-CARE COORDINATION

Our objective is to make it easy to schedule care for WelbeHealth participants. We will coordinate initial and follow-up visits with your office. We generally request appointments within 10 calendar days for routine matters, 7 calendar days for urgent requests, and 2 business days for emergencies.

Call our provider services line at (650) 336-0300 or email our scheduling team at welbehubrequest@welbehealth.com with any questions.

Post-care Coordination Form

Claims Processing

Access the WelbeHealth provider portal using the “Portal” button below, to submit and monitor authorization requests and claims, and to confirm participant eligibility and benefits.

Portal
PAPER CLAIMS

WelbeHealth accepts both paper and electronic claim submissions. Our standard timely filing requirement for claims submission is 90 days.

For submission of claims electronically, use payer ID is WBHCA. For paper claim submission, mail claims to:

WelbeHealth
P.O. Box 30760
Tampa, Florida 33630-3760

PROVIDER APPEALS AND GRIEVANCE

Our complete Provider Appeals and Grievance process is in the provider manual.

Provider Appeals:

All providers can appeal WelbeHealth decisions related to authorization, denial of services, or the processing, payment or nonpayment of a claim

For appeals regarding authorization or payment of a claim for services rendered to WelbeHealth participants, within 30 calendar days of the denial, the provider should initiate an appeal by providing WelbeHelath with written information identifying the claim and specifically describing the disputed action.

Appeal Form

The appeal must be on the contracted provider’s letterhead and contain the following information to identify the claim:

  • Participant name
  • Provider name
  • Dates of service
  • Charges denied/underpaid
  • Grounds for appeal
  • Supporting documentation for the grounds on which the provider is appealing

Submit the appeal to:

WelbeHealth — Attn: Health Plan Services
P.O. Box 30760
Tampa, Florida 33630

To review the WelbeHealth appeal policy, contact your provider relations representative and request policy ADM-NV-03.

Provider Correspondence Cover Page:

If additional documentation is requested or required to process and/or adjust a previously processed claim, please submit the documentation along with the below Correspondence Cover Page. The Correspondence Cover Page should be used after the submission of a claim which has resulted in a request for documentation by WelbeHealth; or if the provider feels additional documentation is warranted to process or adjust a previously received/processed claim.

Please send this completed form and requested documentation to: providers@welbehealth.com or mail to: Attn: Claims Department WelbeHealth PO Box 30760, Tampa FL 33630-3760

Correspondence Cover Page Form


Provider Guidance:

WelbeHealth is committed to assuring that PACE participants are satisfied with the service delivery or quality of care they receive. WelbeHealth has an established grievance process to address participants’ concerns or dissatisfaction about services provided, provision of care, or any aspect of the Program.

Should you want to review the WelbeHealth Grievance policy, contact your Provider Relations Representative and ask for policy QIC-GA-01.

Quality

Information about the WelbeHealth Quality Improvement Plan and Record Keeping, Record Submission, and Records Inspection are in the Provider Manual, including:

  • Medical Record Documentation Requirements
  • Clinical Practice Guidelines
  • Preventive Health Guidelines
  • HEDIS

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