Frequently Asked Questions
Medicaid provides medical coverage to low-income individuals and families. The state and federal government share the cost of the Medicaid program.
Your local Department of Social Services (DSS) caseworker will help determine if you are qualify for Medicaid or NC Health Choice.
Basic Eligibility Requirements
Medicaid may be available to people who are:
- Age 65 or older
- Blind or disabled
- Infants and children under the age of 21
- Low-income individuals and families
- In need of long-term care
- Receiving Medicare
NC Health Choice may be available to people who are:
- Children ages 6 through 18
You also must:
- Be a U.S. citizen or provide proof of eligible immigration status (if you are applying for only emergency services, you are not required to provide documentation of immigration status)
- Live in North Carolina and provide proof of residency
- Have a Social Security number or have applied for one
You are automatically eligible for Medicaid if you receive any of the following:
- Supplemental Security Income (SSI)
- State/County Special Assistance for the Aged or Disabled
Income and Resource Eligibility Requirements
Medicaid and NC Health Choice programs are for low-income beneficiaries. Eligibility is based in part on your income and resources. This amount is different depending on the Medicaid program that fits your age and health care needs. Your local DSS caseworker will help determine your income and resources.
There are many ways to apply. You can apply for NC Medicaid online, by mail or in person at your local Department of Social Services (DSS):
- Online at https://medicaid.ncdhhs.gov/medicaid/get-started/apply-for-medicaid-or-health-choice
- By phone at 1-833-870-550 (TTY 1-833-870-5588)
- In person at your local DSS office. For a list of local DSS offices, go to https://www.ncdhhs.gov/divisions/social-services/local-dss-directory.
Contact your local DSS if you cannot apply in one of these ways.
Find your provider directory. It has a listing of all hospitals in your WellCare health plan network. Your primary care physician or specialist will coordinate your hospital care.
Call 911. Or proceed to the nearest medical facility. Call your primary care physician or our Customer Service Department as soon as possible after the emergency. Make sure we are aware of your situation. Then, we can assist you to receive appropriate follow-up care.
Use the Contact Us form. You can also call the Customer Service number on the back of your Member ID card.
If you are moving, please update your records. Submitting the Change of Address form available in your member handbook. Or, call the Customer Service department with your new address. You can also use the Contact Us form.
Please check your WellCare welcome letter. You can also use the Contact Us form for additional help.
To check claim status, log into the secure portal at https://provider.wellcare.com. The secure portal is for participating WellCare providers that are contracted through Medicaid or Medicare lines of business.
Here are the steps to check a claim status:
- Once you log into the secure provider portal, navigate to the Claims landing page.
- Search for the claim in a variety of ways including: WCN Number, Claim Number, Member ID, Provider ID, Member Name and DOB, Medicare ID, Medicaid ID or DCN.
*Note: Certain items will require that you enter a date range under “Service Date”.
- Select the “Search” button and the claim results will display below.
Yes. WellCare Health Plans, Inc. is pleased to offer providers electronic funds transfer (EFT) and electronic remittance advice (ERA) services at no charge. Offered in partnership with PaySpan Health, you now have access to a secure, quick way to electronically settle claims. Using this no-cost service, providers can settle claims electronically, without making an investment in expensive EDI software.
You can find additional helpful information in your quick-reference guide.
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