Summary of change: WellCare has updated the Clinical Coverage Guideline (CCG) HS-311 for Post-Acute Care.
Updated CCG:
What does this mean for providers?
Effective April 2018, our clinical teams will use the Clinical Coverage Guideline (CCG) HS-311 for Post-Acute Care to ensure services are authorized based on the appropriate services provided and intensity of care reflecting individual medical needs. This information will form the Level of Care determination. Claims will continue to adjudicate based on the authorized level. Reimbursement will align with the approved authorized Level of Care.
Why is this necessary?
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To ensure that members receive the appropriate services and intensity of care based on individual medical needs
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To manage and coordinate care throughout the duration of service
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To ensure that SNF facilities receive appropriate payment for services based on authorized intensity of care
