WellCare/Centene: Retroactive Enrollment Reminders

WellCare/Centene Announcement from 11/13/20:

Retroactive Enrollment Reminders

Did You Know – CMS monitors and scrutinizes retroactive enrollments that result from broker errors during the initial enrollment application process? As such, these largely preventable, broker-related errors present compliance issues for Centene that may have downstream effects on any related broker contractual arrangements. As a best practice, please review all applications prior to submitting to ensure accuracy of the submission.

For further insight, we have identified some of the most common mistakes to watch for:

  • Incorrect effective dates selected
  • Plan name and plan number mismatches
  • Missing required information, and no responses to our requests for information
  • Incorrect plan segment (PBP) selected by agent during agent assisted web application

If you have any further questions, please contact your Cornerstone rep.

Centene/WellCare 2021 Star Ratings

Centene is pleased to announce their 2021 Star Ratings!

Each year, the Centers for Medicare & Medicaid Services (CMS) issues objective ratings on all Medicare Advantage and Medicare Drug plans to determine if they provide high-quality care for their members.

These quality scores include several factors, such as the clinical care members receive, their service experience, and member feedback detailing how well plans did in various categories. Using a one through five-Star rating system, CMS evaluates nearly 50 measures, broken into multiple areas.

Centene oversees CMS Star measures and performance within five chapters:

  • Admin/Ops (service quality)
  • CAHPS (member satisfaction)
  • HEDIS (clinical services)
  • HOS (Health Outcomes Survey)
  • Pharmacy (taking prescribed medications)

Achieving positive quality ratings is vital. These ratings are crucial to Centene members, brokers and partners, and their overall growth. With CMS’ increased focus on patient experience and access to care, Centene must continue to put members first and empower them to partner with their providers to make good healthcare decisions.

Downloadable 2021 Star Ratings:

  • Click here to access 2021 Star Ratings for all Centene health plans.

 

NOTE: 2021 Star Ratings are state- and product-specific.

 

Action Required: Please ensure that you are distributing the most current 2021 Star Ratings. Be sure to dispose of any outdated Star Ratings.

 

WellCare: EFT/ACH Vendor Payment Postponed

WellCare communication from 10/26/20:

WellCare’s transition to a new broker payment vendor is delayed. Originally the transition was to take place on October 30, 2020; now, it will take place on November 13, 2020.

  • The first payout using the new vendor will take place on November 13, 2020.
  • You will continue to receive payment through our existing process and vendor until the transition is completed.

There will be no interruption in broker payments, as we transition to the new broker payment vendor.

 

If you have any questions, please contact your CSM service representative. 

WellCare: AEP is HERE

WellCare Message from 10/2/2020:

AEP is Here! AEP is finally here, and the combination of Centene and WellCare means greater opportunity for you!

Now, you can market and sell up to 5 health plans!

  • Allwell
  • Ascension Complete
  • Fidelis Care
  • Health Net
  • WellCare

Note: Not all health plans are available in all areas.

The easiest and fastest way to ensure that you are offering all plans available in your area and you are credited for each sale is to use the Ascend Enrollment Platform. (Currently, Ascend cannot be used for Fidelis Care enrollments.)

Application and Enrollment

Broker Identifier:

It is crucial that all applications include the correct agent identifier. Ascend will automatically attach your agent identifier to each application you submit: National Producer Number (NPN), Producer ID (PID), or Fidelis Care ID.

When submitting applications OUTSIDE of the Ascend Enrollment Platform, be sure to input the correct agent identifier:

*Fidelis Care Notes:

  • Beginning 10/1/2020, Fidelis Care will begin using a unique broker identifier consisting of the letters FB + NPN, for example: FB123456

Fidelis Care does not accept paper applications.

Ascend:

All health plan information has been loaded into Ascend. Please note, 2021 Enrollment Applications will not be accessible until 10/15.

As of 10/1 you should be able to access 2021 rates and benefits in the Ascend Mobile App. If you are not able to access 2021 plan information, please be sure to update the App. Click here for information on how to download and update the Ascend Mobile App.

Warning! Beginning 10/1/2020, the WellCare Mobile Enrollment Platform and Desktop Enrollment Platform (agent assisted) will be retired and no longer accessible. You will find our 2021 plans, benefits, rates and enrollment capabilities in Ascend.

Additional Resources:

Click here for Application & Enrollment Tools.

2021 CMS Enrollment Guidance Policy Revisions

The Centers for Medicare & Medicaid Services (CMS) has issued annual enrollment and disenrollment guidance revisions for contract year 2021.

All enrollments with an effective date on or after January 1, 2021, must be processed in accordance with the revised guidance requirements.

Significant Changes To Guidance:

  1. Effective for the plan year beginning January 1, 2021, CMS removed the prohibition on beneficiaries with ESRD enrolling in a Medicare Advantage (MA/MAPD) plan. Health plans can accept and process elections made by ESRD beneficiaries that choose to join a MA/MAPD plan during a valid election period.
  2. Special Election Periods (SEP) for Exceptional Conditions: CMS has codified a number of SEPs previously adopted and implemented through subregulatory guidance as exceptional circumstances SEP, additionally two new SEP’s have been added for exceptional circumstances: SEP for Individuals Enrolled in a Plan Placed in Receivership & SEP for Individuals Enrolled in a Plan that has been identified by CMS as a Consistent Poor Performer
  3. Medicare Advantage and Prescription Drug Plan Model Enrollment forms: CMS revised and improved the standard (“long�) model form used for MA/MAPD and PDP enrollments to a new streamlined form. All health plan enrollment applications have been revised in accordance with CMS guidance, including Allwell, Ascension Complete, Fidelis Care, Health Net, and WellCare.
  4. Electronic Signatures: As part of the Electronic Enrollment process, electronic signatures from a beneficiary that affirms his/her intent to complete the enrollment are acceptable. This change only applies to electronic enrollments. The affirmation requirements for the telephonic and paper enrollments remain the same.

 

 

WellCare Partners with Shipt to Provide Free Grocery Delivery

News provided by WellCare- August 3, 2020:

TAMPA, Fla. and BIRMINGHAM, Ala., Aug. 3,  2020 /PRNewswire/ — WellCare, a wholly owned subsidiary of Centene Corporation, announced today an industry-leading partnership with Shipt, a same-day delivery service, to help Medicare Advantage members safely and conveniently access groceries and everyday essentials throughout 2020, providing them with a critical service during the COVID-19 pandemic.

READ FULL ARTICLE 

WellCare – Combined Centene Contract Now Available

A combined Centene Broker Contract is now available.  Contracting must be completed as soon as possible but no later than September 30, 2020.

Click here to access the contracting documents and process notes.

Allwell Contracting and Certification Update

  2021 Annual Certification Training (ACT) will be available on July 7, 2020!

Reminder: Completing the 2021 combined ACT certifies you to market and sell all Centene products, including Allwell, Ascension Complete, Fidelis Care, Health Net, WellCare, for 2020 and 2021 plan years.

Top 5 tips for the ACT Mastery Exam:

1. Recommend browsers include: Google Chrome, FireFox, Safari, or Microsoft Edge.

2. Ensure browser zoom setting is set to 100%.

3. The exam is open book – please take your time.

4. A downloadable version of ACT is available within the Resources section of the training. The PDF can be searched to locate information.

5. For every failed attempt at the exam, a 24 hour lock-out period will take place before a retake is allowed, but the number of attempts is unlimited.

Contracting and Annual Certification Training Reminders:

·     Contracting will begin soon, should be completed as soon as possible, but no later than September 30, 2020.

·     All brokers must review, acknowledge, and complete the combined Centene Broker Contract.

·     Unless you are currently, separately contracted with WellCare, you will not be eligible to market or sell WellCare products, for Plan Year 2020 until the combined Centene Broker Contract and 2021 AHIP & Annual Certification Training (ACT) are completed.

·     You will not be eligible to market or sell any Centene or WellCare products for Plan Year 2021 until the combined Centene Broker Contract and 2021 AHIP & ACT are completed.

·     If you do not complete the combined Centene Contract and/or do not complete 2021 AHIP & ACT before December 31, 2020, your Broker Status will be changed to Suspended, and you will not be eligible to receive commissions for any prior business, including renewals.

·     Completing the combined Centene Contract will not change your current contract level.

 

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Thank you for your continued support.

WellCare: Late Enrollment Penalty Reminders

Late Enrollment Penalty Reminders:

A Late Enrollment Penalty (LEP) is an unwelcome surprise. LEP can be confusing and frustrating to new members often resulting in complaints. When enrolling members please take the time to explain the following important details:

Late Enrollment Penalty (LEP) Details:

  • Medicare beneficiaries may incur a late enrollment penalty (LEP) that is added to their Part D premium if there is a continuous period of 63 days or more, at any time after the end of the individual’s Part D initial enrollment period, during which the individual was eligible to enroll, but was not enrolled in a Medicare Part D plan and was not covered under any creditable prescription drug coverage.
  • Medicare plans that offer Part D benefits are required by CMS to notify enrollees in writing if they determine that a gap in coverage exists as described above. Members will receive instructions from WellCare on how to attest to creditable coverage and will provide a due date for response.
  • If a valid attestation is not received by the due date, Medicare will impose the LEP which will be communicated by WellCare. When this occurs, the member will receive instructions on the conditions and processes for filing a ‘reconsideration’ (appeal).
  • Members have 60 calendar days from the date on the LEP letter to request a reconsideration request of the LEP. If the 60-day timeframe for filing an LEP reconsideration has expired, the enrollee may request a good-cause extension, but must include an explanation why the request is late. If it is approved the LEP will be removed in the next billing cycle.

Please remind your clients aging into or otherwise new to Medicare that, in order to avoid a LEP, they should enroll in (and remain continuously enrolled in) a Medicare plan that offers Part D benefits when they first become eligible unless they have creditable prescription drug coverage through another source, such as a current or former employer or union.