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WellCare Integration

Valued providers for Sunshine Health and WellCare of Florida:

Centene and WellCare/Staywell Health Plan will be bringing our health plans together to better serve our members, providers, partners and communities. For now, Sunshine Health and WellCare of Florida will continue to exist and operate as separate entities. Stay tuned to this page for updates. In addition, we will be hosting Provider Town Halls throughout Florida (or virtually, if needed) in fall 2020 to discuss our integration. We will send you an invite. Hope to see you there!

Centene Corporation finalized its acquisition of WellCare Health Plans, Inc. on Jan. 23, 2020. Centene is the parent company of Sunshine Health; WellCare is the parent company of WellCare of Florida and Staywell Health Plan.

 

Centene’s acquisition of WellCare's Medicaid products, including Staywell Health Plan, will be complete Oct. 1, 2021. Sunshine Health will also operate the Department of Health’s Children's Medical Services Health Plan beginning Oct. 1, 2021. WellCare Medicare products, claims and correspondence procedures are not changing at this time. We value your partnership and want to help ensure proper claim submission to each plan based on the dates of service.

 

Sunshine Health and Staywell Health Plan have been working hard to make the integration of our health plans as seamless as possible for our members, your patients.

In late-July/August, Staywell, Sunshine Health and Children’s Medical Services Health Plan members received letters in the mail telling them of the integration, effective Oct. 1, 2021.

The important thing to know is that members do not need to take any action.

Please assure your Staywell patients they will keep the same great benefits they have now, plus get even more through Sunshine Health. In most cases, members will keep their same care manager, doctors and prescriptions.

On Oct. 1, 2021, the Staywell name will go away and your Staywell Medicaid patients will become Sunshine Health members. Children’s Medical Services (CMS) Health Plan’s name will remain the same, but will be operated by Sunshine Health with the same benefits and services for members.

Member ID Cards

In mid-September, Staywell and CMS members will receive new Member ID cards in the mail. Below is how the ID card will appear.

Questions?

Call Provider Services at 1-844-477-8313, Monday through Friday from 8 a.m. to 8 p.m. Eastern, or contact your Provider Relations Representative.

Sample Medicaid ID card front and back

Sample CMS Title 19 ID card front and back

Sample CMS Title 21 ID card front and back 

 

Sunshine Health is excited to announce that we are expanding the number of transportation service providers to better serve our members and get them to needed medical appointments.

Starting Feb. 1, 2021, new transportation vendors will be implemented for Sunshine Health and Staywell Health Plan, customized by health plan. Members have been notified of these changes. We also want you to be aware of these changes in case you get questions from members.

Through each of the vendors — LogistiCare, Alivi and Medical Transportation Management (MTM) — members can schedule rides on-demand or future rides with a standing order for recurring needs.

Here is a breakdown of services for each vendor:

  • Medicaid: LogistiCare will provide transportation services for members enrolled in Sunshine Health and Staywell Medicaid, Staywell's Serious Mental Illness (SMI) Speciality Plan and Sunshine Health's Child Welfare Specialty Plan.
  • Medicare: LogistiCare will provide transportation services for WellCare of Florida Medicare and Allwell Medicare members.
  • Long Term Care: Alivi will provide transportation services for Sunshine Health and Staywell Health Plan Long Term Care members.

Sunshine Health will continue to operate its Member Advocacy Escalations Team for problems or emergencies that members may experience with transportation needs. If you have complaints or unresolved problems about transportation issues, please call 1-866-796-0530, ext. 6037559. The team can help solve problems Monday through Friday between 8 a.m. and 8 p.m. Eastern. 

Important note: Medical Transportation Management (MTM) will continue to provide transportation services for Florida Department of Health’s Children’s Medical Services Health Plan (CMS) operated by WellCare.

 

Please join us for our 2021 Provider Town Halls

The webinars cover a variety of topics such as status updates on our integration and information that providers need to know for our specialty plans. Space is limited. Please register in advance. Town Halls are scheduled to be offered all year.

Topics detailed during Town Halls include:

  • Integration updates for each product and provider specialty
  • Provider Relations representative overview and meet-and-greet
  • Ability to ask questions and have them answered by subject matter experts and leaders from our departments

Click the title to register:

Previous Town Hall recordings:

 

We are excited to announce the integration of Sunshine Health and WellCare’s Provider Relations teams.

This means you will have one Provider Relations Representative to assist you in serving both Sunshine Health and WellCare of Florida members, including our Medicaid, Medicare and Ambetter members and our specialty health plan members in Sunshine Health’s Child Welfare Specialty Plan, Staywell’s Serious Mental Illness (SMI) Specialty Plan and the Florida Department of Health’s Children’s Medical Services Health Plan (CMS). This change will be effective Aug. 3, 2020.

We expect to fully integrate our two companies in the second half of 2021. We are taking this step now to provide you with more streamlined and efficient service.

We Need Your Feedback

Our goal is to build a best in class Provider Relations team to meet your needs. Your input and feedback is crucial. We will be seeking your opinions about what each of our organizations does best, as well as how we can improve.

When we fully integrate, we will unite all of our products under the Sunshine Health brand. We are committed to keeping you up to date on changes before we make them. Stay tuned to this webpage where you can find all the integration information in one place.

Follow Your Current Contract(s)

For now please continue to treat members from each health plan as you do under your current contract. Our operational systems for each health plan, including Claims and Provider Services, remain separate. If you have questions, your Provider Relations representative is available to help you, regardless of whether your question is about Sunshine Health or WellCare. In some cases, your representative may change. We’ll let you know in advance if that happens. You can also call our dedicated Provider Relations Number at 1-407-551-3200, option 2.

 

Sunshine Health offers dedicated Provider Relations Representatives located in offices across Florida. Find your dedicated representative

 

How does this help my practice?

Your Provider Relations Representative will be specially trained to understand the nuances and needs of your practice. Having one rep will also streamline communications, helping us align accountability, eliminate duplications and provide a consistent message.

Will my rep change? When will I be told?

In some cases, your Provider Relations Representative may change – but in many cases you will simply keep one of your existing representatives. If you will have a new representative, we will let you know in advance.

How does this help/what changes for my patients?

The entire integration process should be seamless to your patients but they will benefit from the extra care and efficiency you receive through this streamlined process.

Will members have/need new ID cards?

For now, members will continue to use separate ID cards. We will let you know in advance when that changes.

Now that I have one Provider Relations Representative for both WellCare and Sunshine Health, can I also file claims in a single place? Can I verify membership in a single place?

Not yet. Please continue following the same claims, authorization and verification processes you have been using under your current contract(s). We will let you know when we expect those systems to be fully integrated.

Are member benefits also changing?

Member benefits are not changing. Please follow current processes until further notice.  

Will my WellCare members be eligible for Sunshine Health Provider Quality Incentives?

For now, incentive programs will remain separate. Please follow the current process until further notice.

What if I communicate with Sunshine Health through a vendor but directly work with WellCare?

If you work with a vendor for Sunshine Health, you will continue to work with that vendor.

Do I now accept both Sunshine and WellCare patients if previously I only accepted one or the other?

No, your contract(s) remain the same.

Why should I attend a Provider Town Hall if I already meet regularly with my Provider Relations Representative?

Integrating the Provider Relations team is one of the first steps toward fully integrating our companies in 2021. We want you to have input and stay informed every step of the way. At the Town Halls, you’ll have an opportunity to meet your Provider Relations Representative, hear from Subject Matter Experts and take part in a Q&A session. We’ll let you know if these will be in person or online.

Does this change to which specialists I can refer my patients?

Our provider networks are not yet combined. Please follow your contract(s) for now.

When can I expect outreach regarding my existing contract(s)? What if I am contracted with Sunshine Health or WellCare and not both Health Plans?

Providers participating only with Sunshine Health will maintain that agreement and Staywell members will become Sunshine Health members in October 2021. Providers in both networks will receive communications clarifying which contracts will govern by product no later than July 1, 2021.