Wellcare of Georgia Medicaid HMO June 1, 2006

1. Product • Wellcare of Georgia Medicaid HMO • June 1, 2006 • Wellcare has delegated credentialing to Kids First. Therefore, it will not be necessary to complete a WellCare of Georgia application. • It will be necessary to complete an application for Physician Extenders (NP’s & PA’s) using the Allied Health Application found on the WellCare website. • 107% of the Georgia Medicaid Fee Schedule with a $3 Per Member Per Month Management Fee. Top 140 Fee Schedule codes are attached. • Physician listings are available via the internet on the website, http://georgia.wellcare.com • Referrals are not required for the following (this list is not inclusive of all services not requiring referrals; please see the Provider Quick Reference Guide for additional information): • Plain X-rays by PCP and Specialist • Labs sent to an In Network Lab (Lab Corp) • Family Planning Services • Initial Consultation from a Specialist (see CPT codes listed in Quick Reference Guide) Contract Effective Date Reimbursement Network Medical Management

2. Precertification is required for the following (this list is not inclusive of all procedures requiring precertification; please see the Provider Quick Reference Guide for additional procedures) • Hospital Admission/Observation • All procedures by specialists • Nutritional Counseling • Respiratory Therapy Services • Physical and Speech Therapy • DME >$200 • All Radiology Services except Plain X-Rays • All diagnostic services provided at non-contracting facilities • All non-emergent Out of Network services • Emergency admissions require notification within 24 hours. Refer to back of member’s (patient’s) card for contact information. Medical Management (continued)

3. All claims should be submitted on a standard HCFA 1500 form to the following address: • WellCare Health Plans, Inc. • Georgia Region • PO Box 31224 • Tampa, Florida 33631-3224 • Electronic Submission: • EDI Payor ID: • 14163 – Legacy, Availity, WebMD, SSI • 77004 - ACS • Co-payment information and benefits should be verified by reviewing the member’s insurance card. • All claims should be submitted within 180 days of date of service via mail or electronic submission method to the appropriate payor, as indicated on the member’s ID card. • WellCare • WellCare Main Line 866-231-1821 • WellCare Provider Relations 866-231-1821 • Eligibility & Benefits 866-231-1821 • Pre-Certification 866-231-1821 • Claim Status 866-231-1821 • Kids First Pediatric Alliance • Main number 770-333-0033 Claims Submission Phone Numbers