WellCare Integration FAQs
Sunshine Health operates as Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA), Long Term Care (LTC) and a Child Welfare Specialty Plan (CW) in all regions through a contract with the Agency for Health Care Administration (AHCA).
In addition, Sunshine Health offers:
- Health Insurance Marketplace plans through its Ambetter brand.
- Medicare Advantage plans through its Allwell brand through a contract with the Centers for Medicare and Medicaid Services (CMS) and a D-SNP plan through contracts with CMS and AHCA.
WellCare of Florida’s Staywell Health Plan operates as a SMMC MMA and LTC plan in Regions 1-9 and 11, and as a Serious Mental Illness (SMI) Specialty Plan statewide through a contract with AHCA.
WellCare of Florida also operates:
- The Florida Department of Health’s (DOH) Children’s Medical Services Health Plan in Regions 1 through 11 through a contract with the DOH.
- Medicare Advantage plans through a contract with CMS and a D-SNP plan through contracts with CMS and AHCA.
Sunshine Health and WellCare of Florida will continue to be separate legal entities and operate as separate plans pursuant to our respective contracts with AHCA and other government agencies.
For now, we are preserving all of our Florida brands, and our members will continue to use their existing Member ID cards. You will continue to see our brands in the community and in our marketing during this time. Sunshine Health and WellCare of Florida will provide advance notice to our providers and members of any future changes to our brands or provider/member materials.
As we work to combine the best of both companies, we expect the transition period to last for approximately 18-24 months. During the transition period, we will work with AHCA and DOH to integrate our operations under one plan. Decisions about branding and which legal entity will be the surviving entity have not been made.
Nothing is changing for you right now. We will continue to operate in the same way, offer the same services, cover the same members and honor the same provider contracts, as we have in the past.
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. Our respective members will continue to use the same Member ID cards (e.g., Sunshine Health, Staywell or Children’s Medical Services Health Plan). We will continue to operate all lines of business as we did prior to the transaction closing.
During the transition period, Sunshine Health or WellCare of Florida may contact you with a notice of changes to your provider contract or to offer you a new provider contract, to secure your valued services for all the Florida brands that are now under Centene ownership.
Nothing is changing right now regarding your provider contracts with Sunshine Health or WellCare of Florida.
- If you have a provider contract with Sunshine Health, you will maintain your provider contract with Sunshine Health during the transition period. This contract will continue to serve the Sunshine Health members in the plans and regions in which Sunshine Health operates. The rate under your Sunshine Health provider contract will continue to apply for services rendered to Sunshine Health members.
- Similarly, if you have a provider contract with WellCare of Florida, you will maintain your provider contract with WellCare of Florida during the transition period. This contract will continue to serve the WellCare of Florida members in the plans and regions in which WellCare of Florida operates. The rate under your WellCare of Florida provider contract will continue to apply for services rendered to WellCare of Florida members.
At this time, your contract(s) will not be used to expand to other new populations or product lines that weren’t previously covered under those contracts.
During the transition period, Sunshine Health or WellCare of Florida may approach you with a notice of changes to your contract or to offer you a new contract to cover the Florida brands that are now under Centene ownership.
Please continue to submit claims the same way you did before the transaction closed, as per your respective Sunshine Health or WellCare of Florida Provider Manuals. These manuals remain available to you on the internet at the following websites:
In addition, members’ ID cards should continue to drive the process you adhere to when you call for eligibility or have claims questions.
Sunshine Health and WellCare of Florida will provide you with advance notice of any future changes to our respective claims processes.
Nothing is changing right now. Sunshine Health and WellCare of Florida Provider Manuals will continue to apply to the operation of each plan’s existing contracts.
Remember, members’ ID cards should continue to drive the process you adhere to when you call for eligibility or have claims questions.
During the transition period, Sunshine Health or WellCare of Florida may approach you with a notice of changes to your contract or to offer you a new contract to cover the Florida brands that are now under Centene ownership.
For now, you will not see any changes in how your provider contract(s) is/are administered. Your claims will continue to be paid in a manner that is consistent with your current experience. The member ID card drives the claims process and the contract under which eligible services are paid.
If there are any changes in the future, we will communicate them to you well in advance.
During the transition period, each contract will continue to preserve its rates and serve the same membership it has always served. Nothing is changing regarding your contracts right now.
In regions where both Sunshine Health and WellCare of Florida offer Medicaid plans, we will continue to apply the rates in the respective contracts for the corresponding membership. Members’ ID cards drive the claims process and the contract under which eligible services are paid.
If there are any changes in the future that may affect the rate in your provider contracts, we will communicate them to you well in advance.
Sunshine Health and WellCare of Florida are diligently working to develop a detailed transition plan to ensure the transition is smooth for enrollees. This plan will emphasize our enrollees with complex medical needs, and include such elements as in-person Open Houses at our regional welcome centers hosted by Sunshine Health and WellCare, detailed enrollee FAQs (that we will also make available to providers), enhanced care management support for enrollees with complex needs, and a continuity of care period.
Sunshine Health: Contact your Provider Relations representative, or Provider Services at 1-844-477-8313.
WellCare of Florida: Contact your Provider Relations representative, or Provider Services at 1-866-334-7927.
Children’s Medical Services Health Plan: Contact your Provider Relations representative, or Provider Services at 1-866-799-5321.
In addition, we plan to host one or more webinars to review the information in this FAQ and address any additional questions. The webinar dates will be listed on our respective websites with instructions on how to attend.