News from the NIC - Wellcare Update

The NYSCA Insurance Committee (the NIC) has been in contact with American Specialties Health (ASH) to better define the benefits available to Wellcare members. Please note that All Wellcare insureds DO NOT have the insurance rider which covers all of the services listed in the ASH G9 fee schedule. NYSCA members have reported a difference in benefits when checking eligibility on ASHLink vs talking to a representative or when performing an ASHLink Inquiry.

American Specialties will be updating the ASH Wellcare Client Summaries to ensure the information is accurate and easily comprehended by all parties. We look forward to the update. At present, it appears that the ASHLink eligibility information is providing the correct information regarding covered services.

The NIC recommends verifying eligibility at a minimum of annually (when the patient's policy reviews - which is not always January 1st) and when the patient changes insurances. Again, this is a minimum.

Remember to utilize the applicable ASHLink Billing Acknowledgement Form, as you may be entitled to charge the patient for non-covered services. Following this process ensures you are compliant, and allows you to collect the additional fees due from your patient.

More updates to follow as we learn them from American Specialties.

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