FAX ALERT - August 2, 2006
FAX ALERT
GEORGIA OB-GYN SOCIETY
PHONE 770.904.0719 FAX 770.904.5251
August 2, 2006
TO: All Members
FROM: Pat Cota
Medicaid WellCare CMO
The Society has received numerous calls regarding the new Medicaid CMOs. The following is an update related to meetings with WellCare. We are meeting with WellCare on an ongoing basis to discuss problems.
Wellcare has clarified its policy on the following which do not require an authorization:
- Rhogam
- Depo-Provera
- Circumcisions done during initial birth hospitalization
WellCare requires preauthorization for:
- Pregnancy ultrasound (covers one U/S without prior authorization)
- Nonstress Tests
*U/Ss and NSTs done in emergency situations do not require preauthorization but do require submission of clinical information within one business day of the test.*
The Society continues to meet with representatives from WellCare to discuss issues such as:
- Payments and timeliness of payments
- Payment for items denied due to lack of prior authorization
- U/S and NST and other prior authorization requirements
- Amount of paperwork required
- Referral process for Gyn services
- Approval process for hospitalizations
- Prescription of birth control and prenatal vitamins
We will keep you informed as these issues are resolved. We encourage you to stay in close communication with your local CMO representatives to obtain correct billing information and as we continue to work on solutions to problems identified.