H0934_1034Pas_WelbeHealthTestimonial_ CMS Approved 07/20/2022, H1544_1034Lon_WelbeHealthTestimonial_ CMS Approved 07/20/2022, H2384_1034Fre_WelbeHealthTestimonial_ CMS Approved 07/20/2022, H6317_WBHWebLocation_166_SanJose_CMS Approved 01/05/2024, H8082_WBHWebLocation_166_Modesto Approved 5/14/2024, H1917_WBHWebLocation_166_RIVCVY Approved 5/14/2024, H1544_WebCAR _CMS Approval Pending XX/XX/XXXX, H0934_WebLdgPgPT Approval Pending XX/XX/XXXX, H1544_WebLdgPgPT Approval Pending XX/XX/XXXX, H1917_WebLdgPgPT Approval Pending XX/XX/XXXX, H2384_WebLdgPgPT Approval Pending XX/XX/XXXX, H6317_WebLdgPgPT Approval Pending XX/XX/XXXX, H8082_WebLdgPgPT Approval Pending XX/XX/XXXX
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:
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.
CONTRACTS
Contracted providers are an essential part of delivering quality care to our members. If you are interested in working with us, please contact us.
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.
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.
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.
News & Communications
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 any inquiries or need further assistance, please contact our provider service line at
(650) 336-0300 or email providers@welbehealth.com.
Northern California
Fresno
1649 Van Ness Ave
Fresno, CA 93721
Main Local Phone #: (559) 777-6722
Clinic Fax: (833) 963-2082
Modesto*
(*Alternative Care Setting)
1224 Scenic Drive
Modesto, CA 95350
Main Local Phone #: (888) 530-4415
Clinic Fax: (833) 573-2336
San Jose
1799 Hamilton Avenue
San Jose, CA
Main Local Phone #: (408) 889-1216
Clinic Fax: (833) 449-4676
Stockton
582 East Harding Way
Stockton, CA 95204
Main Local Phone #: (209) 442-6077
Clinic Fax: (844) 548-3818
Southern California
Long Beach
1220 East 4th Street
Long Beach, CA 90802
Main Local Phone #: (562) 206-1681
Clinic Fax: (855) 712-7837
North Hollywood
11633 Victory Boulevard, Suite 100
North Hollywood, CA 91606
Main Local Phone #: (888) 530-4415
Clinic Fax: (818) 691-1460
Pasadena
50 Alessandro Pl. Suite A20
Pasadena, CA 91105
Main Local Phone #: (626) 314-1411
Clinic Fax: (855) 245-2961
Rosemead
8399 Garvey Avenue
Rosemead, CA 01770
Main Local Phone #: (888) 530-4415
Clinic Fax: (833) 471-4510
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.
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.
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.
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
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