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Information and Resources on Hurricane Helene:

Are you in North Carolina and need help because of Hurricane Helene? This website has helpful information. Visit the DPS website.

Provider Updates

We would like to inform you of important updates related to authorization requests and appeals, invite you to attend our upcoming Provider Claims Clinics taking place throughout 2025, and introduce the launch of our new Provider Portal.

Changes to Retrospective Authorization Requests and Appeals Process

Effective May 1, 2025, all retrospective authorization requests must be submitted directly to WellCare's Utilization Management (UM) team.

Key Updates:

  • Submit to UM: Retrospective authorization requests should be sent to the UM team, not the Appeals department.
  • If Approved: If the retrospective authorization is approved and a claim was previously denied for lack of authorization, providers must resubmit the claim for payment.
  • If Denied: If the authorization request is denied, providers will receive appeal rights information.
  • Supporting Information: When submitting a retrospective authorization request, please include any extenuating circumstances that prevented obtaining prior authorization before services were rendered.
  • Appeals Department Changes: Starting May 1, 2025, the Appeals department will no longer accept retrospective authorization requests unless a prior denial was issued by the WellCare UM team.

Join Us – 2025 Provider Claims Clinics

We are pleased to offer in-person Provider Claims Clinics across the state in 2025.

These events are designed to:

  • Address claims payment or processing issues
  • Remove barriers to doing business
  • Strengthen provider relationships

➨ Register here for a Provider Claims Clinic
(Select the date and location on Calendly that work best for your team.)

  • Clinic locations will include Greensboro, Raleigh, Asheville, Charlotte, Greenville, and Lumberton.

Note: The Provider Relations team will not be attending these sessions, but a list of registered providers will be shared prior to each event.

New Optum Provider Portal Launching June 15!

We’re excited to introduce Optum’s new Provider Portal — designed to simplify payment integrity processes and enhance your experience.

Key Benefits:

Simplified Medical Record Management: View and upload all medical record requests in one secure location.
Real-Time Status Tracking: Easily track the status of your submissions.
Improved Communication: Access review outcomes and rationales for greater transparency.
Go Paperless: Choose digital communications for faster, more efficient service.

What’s Changing:
Starting June 15, 2025, providers will be directed to a new URL (included on Optum’s medical record request letters) to upload documentation.

  • Registered Users: Self-register to access the full range of enhanced portal features.
  • Non-Registered Users: Continue to upload documentation with the same functionality you currently use.

Need Help with Registration?

For additional support, contact Optum Customer Service at 855-819-5909 or follow the instructions in the attached Payment Integrity Portal User Guide.

Next Steps:

Training Opportunities: Stay tuned for upcoming training sessions hosted by your Provider Relations representative.

For questions or support, please contact your Provider Relations representative at NCProviderRelations@wellcare.com.

Thank you for your continued partnership. We look forward to supporting you through these updates and meeting with you at one of our Provider Claims Clinics.

Sincerely,
WellCare of North Carolina