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WELLCARE OF NEW YORK

Main numbers: 1-800-421-1755 1-845-334-4000 Medical Director

Mental Health/Substance Abuse Imaging- NYMI Magellan Behavioral Health 1-800-533-1206 1-800-836-2256 Laboratory- Laboratory Corporation of America 1-800-854-5940(Specimen Pick-up) 1-800-223-0631(Results) 1-800-631-5250(Ask for Supply Department) Follow prompts to reach the following departments: Ø Ø Ø Ø Medical Emergency Assistance Member Services (benefits, eligibility, PCP changes, enrollment, etc.) Provider Relations Medical Management (pre-authorization, referrals, in-patient admissions)

Claims Submission Ø When submitting electronically, please utilize Carrier ID#14164 Ø Paper claims should be mailed to the following address: WellCare of New York, Inc. P.O. Box 271000 Tampa, FL 33688 Referral Process Ø Ø Ø Ø WellCare members must have a valid paper referral form in order to visit a specialist. A Referral is valid for two months for a maximum of 3 visits. A Referral to a non-participating provider is not valid. Paper referrals are for consultations only. Any additional services performed by the specialist may require pre-authorization from WellCare's Medical Management Department.

Referral Form Fax Number After issuing a referral, please fax a copy of the referral form to 1-800-246-7983 so the referral information can be entered prior to the claim being received. Pre-authorization Process

Please allow approximately 5 business days for WellCare's Medical Management staff to issue pre-authorization numbers. The medical management staff will be able to process your request in the least amount of time if the pre-authorization forms are filled out completely and if all pertinent office/operative records are submitted along with the request form. Please refer to the attached list of services that require pre-authorization from WellCare's Medical Management Department.

WellCare of New York "cheat sheet" Page 2 of 2

Pre-authorization Fax Number

Please fax all authorization requests to 1-800-246-7983 using the pre-authorization request forms provided by WellCare. Senior Health Enrollment 1-800-439-9355 Healthy Choice / Child Health Plus Enrollment 1-800-334-4069

WELLCARE OF NEW YORK, INC.

EFFECTIVE 5/1/98

Following is a list of services which do require precertification/authorization: · All elective admissions · All emergent admissions · All outpatient or same day surgeries · Office surgeries · Cardiac stress tests (including thallium stress tests) · Cardiac catherization · Colonscopies · Upper GI endoscopies · Pain management · Betaseron/Pulmozyne or any high end long-term drug therapy · Amniocentesis/CVS (chronic villi sampling) · Sleep studies/Polysomnography · Infertility treatment (if rider purchased) · Mental health services both OP and IP (through Merit Behavioral Care) · Home health, DME, prosthetics, orthotics, home infusion · Subacute rehabilitation facility and HOSPICE · Skilled Nursing Facility · Outpatient chemotherapy · Echocardiography · MRI's, MRA's · Angiography/Aortography · CT Scans · Bone densitometry · All pulmonary function testing with the exception of routine spirometry · 24 hour EKG monitoring · Orthoptic/Pleoptic Training · Cardiac rehabilitation · Dialysis · Speech therapy, occupational therapy, physical therapy · Allergy injections · Therapeutic (treatment) radiology Following are services which do not require precertification/authorization: **Pertains to participating providers only** · Routine spirometry · Electro cardiograms · Non-invasive diagnostic radiology (excludes MRI's, CT scans, angiography, bone densitometry, aortography) · Lab work · Inhalation treatments · Allergy skin testing · Doppler studies · Duplex scans · Flexible sigmoidoscopies

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Acupuncture (with Alternative Care Rider) Coverage for six (6) visits to a WellCare participating acupuncturist for the diagnosis and treatment of disease, injury or illness

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