D-SNP Frequently Asked Questions for Providers
I am a provider/PCP contracted on the D-SNP network, do I have to be contracted with a Medi-Cal plan to provide Medicare covered services to Wellcare By Health Net D-SNP members?
No. You do not need to be contracted with Health Net Medi-Cal, CalViva Health Medi-Cal, or any other Medi-Cal plans to provide Medicare covered services to our D-SNP members.
You would only need to be contracted with CalViva Health Medi-Cal or Health Net Medi-Cal if you are providing Medi-Cal covered services not covered by Medicare (such as LTC or CBAS).
If I am a provider that provides services only covered under Medi-Cal such as Long Term Care (LTC), Community Based Adult Services (CBAS), Community Supports, Durable Medical Equipment (DME), and Medi-Cal covered transportation, what provider network do I need to be contracted with?
You need to be contracted with Health Net Medi-Cal.
What provider network does a D-SNP member use for Primary Care, Specialists and facilities through a Medical Group/PPG?
D-SNP network.
Can a D-SNP member enrolled with Wellcare By Health Net who also has Health Net or CalViva Health for Medi-Cal see a Medi-Cal Network provider for Medicare covered services (such as Primary Care, Specialists and Facilities)?
Only if that provider is also contracted on our D-SNP Network.
Can a new member continue to see a non-network provider when they join the D-SNP plan?
Yes. Members new to a D-SNP plan are eligible for continuity of care for 12 months from enrollment if certain circumstances are met. Please see the Provider Operations Manual.
Who do I contact if I want more information about joining the D-SNP provider network?
Non-participating providers can get more information about joining our plan here.
What if a member is seeing a primary care or a specialist provider who is not in our D-SNP network?
Advise the member to utilize the Provider Search tool to look up participating providers within the D-SNP network, which can save the member of the out of network provider cost. You can also advise the member to contact the health plan by using the Member Services phone number on the back of their ID card for a provider search or PCP assignment.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
Where should the providers route the Wellcare By Health Net D-SNP members when they have questions about Medicare and Medi-Cal benefits?
Inform the member to contact the health plan by using the phone number on the back of their ID card for any Medicare and Medi-Cal benefits related questions.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
If any provider denies a service to a member, where should I direct the member?
Remind the member that any referral for services which require an approval will generate a written response to them. If denied, the member will be provided with their appeal rights.
Member can contact Member Services phone number on the back of their ID card for support.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
What types of community support are available to a Wellcare By Health Net D-SNP member through their Medi-Cal Health Plan? How does the member access the Medi-Cal covered Community Supports?
The member can contact our Care Management team by calling the phone number 833-340-0083 to get help with the Medi-Cal covered community supports.
If the member is aligned with us through Health Net Medi-Cal, CalViva Health Medi-Cal or Community Health Plan of Imperial Valley (CHPIV), the following resources are available.
Please see the following Medi-Cal information in the Provider Library:
For Wellcare By Health Net D-SNP members enrolled in Health Net Medi-Cal or CHPIV; search and submit a referral for Community Supports.
For Wellcare By Health Net D-SNP members enrolled in CalViva Health, search and submit a referral for Community Supports at the CalViva findhelp tool.
Research the findhelp platform, which can provide the member with the Community Supports, and help the member get connected to the services. You can also submit a request for care coordination to Wellcare By Health Net using the referral form (PDF).
The Public Programs team will help our members connect to these Community Supports via help_referral@healthnet.com.
All providers are identified in the provider directory under "Other Facilities" Members can self-refer to the Community Support service.
The Community Resource/Supports may include, but is not limited to, the following services:
- Housing Transition Navigation Services (homeless, or about to become)
- Housing Deposits
- Housing Tenancy and Sustaining Services
- Short-Term Post Hospitalization Housing
- Recuperative Care (medical respite)
- Respite Services
- Day Rehabilitation
- Nursing Facility Transition/Diversion to Assisted Living Facilities
- Community Transition Services/Nursing Facility Transitions to a Home
- Personal Care and Homemaker Services
- Environmental Accessibility Adaptations (home modifications)
- Meals/Medically Tailored Meals
- Sobering Centers
- Asthma Remediation
How can I help a member who is having a hard time scheduling an appointment with the county to access County Behavioral Health Services (covered by Medi-Cal and a carve out)?
Inform the member that they can contact Member Services phone number on the back of their ID card for support.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
Where should I direct a member who requests a transportation for medical appointments (or other allowable locations, i.e., pharmacy pick up)?
Members should contact the transportation vendor directly using the phone number listed on their ID card. Or they can also call Member Services for assistance.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
How is transportation coordinated between Medicare and Medi-Cal?
If the member has transportation benefits through their Medicare Advantage/D-SNP plan, those must be exhausted before accessing the unlimited transportation benefits through their Medi-Cal managed care plan.
Who does office/member call if the drug is NOT on the formulary and needs to be treated as an exception in order to get covered?
Submit the prescription request to the pharmacy. It should go through the normal prior authorization process for exception.
Are incontinence supplies covered for D-SNP members?
Yes, the incontinence supplies are covered through their Medi-Cal plan.
How does the D-SNP members access incontinence supplies?
If the member has Health Net Medi-Cal, CalViva Health Medi-Cal, or CHPIV Medi-Cal, the provider office first needs to submit the incontinence supply prescription to the Participating Provider Group and obtain a denial. Once the Medicare denial letter is received, fax the documentation to one of the contracted DME vendors, J&B Medical Supply Company LLC or Byram. The documentation should include member demographics, Medi-Cal ID number, prescription for incontinence supplies, copy of the Medicare denial, and quantity and types of needed supplies.
If the member has a different Medi-Cal plan in Orange, San Bernardino, Riverside, San Diego, Placer, Kern, or San Francisco, submit a referral using the Provider Portal. The list of covered incontinence medical supplies is available in the Provider Ops Manual.
Contact our Care Management team by calling 833-340-0083 or sending an email to centenecmescalationsmedicare@centene.com for help.
Are diabetic supplies fully covered for D-SNP members?
Yes, our D-SNP plan covers 80% and the remaining 20% must be billed to Medi-Cal Rx by the pharmacy.
What happens if the member is charged a copay at the pharmacy for diabetic testing supplies?
The member should contact the Member Services using the number in the back of ID card if they are charged with a copay. D-SNP members are not responsible for copays.
Where should I direct a member who needs to apply and qualify for In Home Support Services covered by Medi-Cal?
Submit a referral using the Provider Portal. Contact our Care Management team by calling 833-340-0083 or sending an email to centenecmescalationsmedicare@centene.com for help.
Where should I direct a member who needs access to Community Based Adult Services (CBAS - adult day care)?
Submit a referral using the Provider Portal. Contact our Care Management team by calling 833-340-0083 or sending an email to centenecmescalationsmedicare@centene.com for help.
What are dual eligible Special Needs Plans (D-SNPs)?
Dual eligible Special Needs Plans (D-SNPs) enroll individuals who have Medicare and Medicaid (Medi-Cal).
Wellcare By Health Net has D-SNP plans in Amador, Imperial, San Joaquin, Stanislaus, Calaveras, Tuolumne, Fresno, Kings, Madera, Los Angeles, Sacramento, and Tulare. And Kern, Placer, San Francisco, Orange, Riverside, San Bernardino, San Diegon are categorized as "no-sell" counties.
Why should a dual eligible beneficiary join a D-SNP?
A dual eligible beneficiary should join a D-SNP because it provides a more streamlined, hassle-free experience in navigating through benefits. This is because the plan provides care coordination services designed to help arrange services on the member's behalf, and often offers extra benefits beyond what beneficiaries can get from original Medicare and Medi-Cal.
Which categories of dual eligible beneficiaries can enroll in a D-SNP?
For Wellcare By Health Net D-SNPs, enrollees must be Full Benefit Dual Eligible, Qualified Medicare Beneficiary Plus and Specified Low-Income Medicare Beneficiary Plus.
Definitions of all types of Qualified Medicare Beneficiary programs are available on the Centers for Medicare & Medicaid Services Medicare-Medicaid Coordination Office website.
Will partial dual eligible beneficiaries be able to enroll in an exclusively aligned enrollment D-SNP offered by Wellcare By Health Net?
No, only full benefit dual eligible beneficiaries will be able to enroll into an exclusively aligned enrollment D-SNP if there is one offered in their county of residence.
What are the types of DSNP plans?
EAE DSNP and regular non-EAE DSNP.
What counties have a Wellcare By Health Net D-SNP Plan in but cannot grow/sell in 2025?
- Wellcare Dual Liberty (HMO D-SNP) - H3561- 001 – Kern, Placer and San Francisco
- Wellcare Dual Liberty (HMO D-SNP) - H3561-009 – Orange, Riverside, San Bernadino and San Diego
What are the new counties for Wellcare By Health Net D-SNP for 2025?
- Wellcare Dual Liberty (HMO D-SNP) - H3561- 001 – Tuolumne and Calaveras counties
What is exclusively aligned enrollment (EAE)?
Exclusive aligned enrollment occurs when both contracts, D-SNP and Medi-Cal, are held or administered by the same parent organization/company and alignment of this enrollment is facilitated.
This approach ensures coordinated care with integrated benefits, including a single member ID card, one care team, and one health plan managing all services—from medical appointments and supplies to transportation and long-term support. Members also have access to one comprehensive network of providers and may receive additional benefits such as dental, hearing, or vision coverage, as outlined in the Member Handbook. This makes it feel and function like one plan to the member.
Enrollment automatically changes a member’s Medi-Cal plan to the same parent organization’s plan, with the state/DHCS handling the switch.
Wellcare By Health Net’s parent company is Centene, Inc. For Centene plans in California, the exclusively aligned enrollment D-SNP plans are:
- Wellcare Dual Align – Wellcare By Health Net D-SNP with a Health Net Medi-Cal plan in Los Angeles, Sacramento, and Tulare.
- Wellcare CalViva Health Dual Align* – Wellcare By Health Net D-SNP with a CalViva Health Medi-Cal plan in Fresno, Kings, and Madera counties.
* CalViva Health is a Medi-Cal Managed Care Plan (MCP) and is the Local Initiative Health Plan for Medi-Cal managed care in Fresno, Kings, and Madera Counties. CalViva Health is a full-service health plan contracting with the Department of Health Care Services (DHCS) to provide Medi-Cal Covered Services to Medi-Cal managed care enrollees under the Two-Plan model in all zip codes in Fresno, Kings, and Madera Counties. CalViva Health contracts with Health Net Community Solutions, Inc. on a capitated basis to provide and arrange for Medi-Cal Covered Services in all zip codes in Fresno, Kings, and Madera Counties. Health Net Community Solutions, Inc. is a subsidiary of Health Net, LLC and Centene Corporation, and is the CalViva Health MCP’s Contracted Administrator in all zip codes in Fresno, Kings, and Madera Counties.
Which provider network does the member choose when they enroll in Wellcare Dual Align or Wellcare CalViva Health Dual Align?
Members must choose a PCP and a medical group from our Wellcare by Health Net D-SNP network.
What happens when a beneficiary applies for enrollment into an exclusively aligned enrollment D-SNP?
Enrollment in the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member's Medi-Cal plan to the same parent organization.
These plans will be available through various health plans in multiple counties throughout California.
Example:
- Mr. Smith is a full dual beneficiary with Medicare fee-for-services and Plan A for his Medi-Cal managed care plan.
- Mr. Smith applies for enrollment into Plan B's exclusively aligned enrollment D-SNP to take advantage of care coordination and benefits. Mr. Smith can choose a primary care physician/participating physician group within Plan B's provider network on his exclusively aligned enrollment D-SNP application.
- When approved by the Centers for Medicare & Medicaid Services, Mr. Smith's Medi-Cal managed care plan will change automatically to Plan B's Medi-Cal managed care plan.
Will a beneficiary who lives in a rural or unincorporated area be able to enroll in an exclusively aligned enrollment D-SNP?
Only if one is offered in the service area where the beneficiary lives. Medicare.gov can help identify plans available in the ZIP Code of the beneficiary.
What are the benefits of EAE D-SNP plan?
Because the Medicare and Medi-Cal services are administered by the same parent organization, the two plans make it feel and function like one plan to the member.
This approach ensures coordinated care with integrated benefits, including a single member ID card, one care team, and one health plan managing all services—from medical appointments and supplies to transportation and long-term support. Members also have access to one comprehensive network of providers and may receive additional benefits such as dental, hearing, or vision coverage, as outlined in the Member Handbook.
What are the Medicare hearing benefits for the Wellcare By Health Net D-SNP members?
Refer the member to check the member's plan benefit material and evidence of coverage (EOC) for the covered hearing benefits.
How can I help a patient who needs more information on the D-SNP covered Hearing benefits?
Members can contact Member Services for assistance.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
What are the Medicare vision benefits for the Wellcare By Health Net D-SNP members?
Refer the member to check the member’s plan benefit material and evidence of coverage (EOC) for the covered hearing benefits.
What are the Medi-Cal vision benefits for the Wellcare By Health Net D-SNP members?
- Medi-Cal will cover up to $100 after Medicare allowance is exhausted.
- Rendering provider needs to submit a secondary claim to the Medi-Cal Plan with proof of Medicare plan payment.
How can I help a patient who needs more information on the D-SNP covered Vision benefits?
Members can contact Member Services for assistance.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
Where should I direct a member who requests a transportation for medical appointments (or other allowable locations, e.g., pharmacy pick up, doctor’s office visit for medical services, dental visits, or behavioral health treatment visits)?
Members should contact the transportation vendor directly using the phone number listed on their ID card. Or they can also call Member Services for assistance.
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
There is no trip limit when you combine the Medicare and Medi-Cal benefits.
How is transportation coordinated between Medicare and Medi-Cal?
If the member has transportation benefits through their Medicare Advantage/D-SNP plan, those must be exhausted before accessing the unlimited transportation benefits through their Medi-Cal managed care plan.
If a member still has transportation benefit through their Medicare Advantage/D-SNP plan, request for a higher mode of transportation when calling the transportation vendor. If a member has exhausted the Medicare Advantage/D-SNP plan and need a higher mode of transportation, a Physician Certification Statement (PCS) form is required to be filled out by the physician/provider office and faxed to Care Ride Unit (CRU) team's fax number at 833-701-0051.
What dental benefits do Wellcare By Health Net members have access to?
Check the member's plan benefit document to identify what the member's dental benefits are.
Who is the D-SNP dental vendor for the Wellcare By Health Net/Wellcare By Health Net in Partnership with CalViva Health members?
Delta Dental of California.
Can the members continue to see the Medi-Cal dentist when they join the Wellcare D-SNP plan?
Yes, the members can continue to see their Med-Cal dentists for Medi-Cal covered dental services.
Can the members see the Medi-Cal dentist for the D-SNP covered services?
Only if that dentist is on the Delta Dental Medi-Medi Network.
Are the benefits coordinated between D-SNP covered benefits and Medi-Cal covered benefits?
No, there is no coordination of benefits because the benefits do not overlap between the two plans.
Wellcare's D-SNP dental coverage is intended to supplement the Medi-Cal covered dental services and covers services which are NOT covered by Medi-Cal dental program.
What is the best way to verify dental benefit coverage for D-SNP under Delta Dental?
D-SNP plan's evidence of coverage for dental services covered by Delta Dental can be found here.
How does a member access their Medi-Cal dental benefits?
Delta Dental Dentists who the members are assigned to are in the Medi-Cal Dental Fee For Service network so the member can access both their Medi-Cal and D-SNP dental benefits through that dentist.
What does the member receive when they are enrolled with Delta Dental?
Upon enrollment, each member receives a Delta Dental ID card & Letter advising of the dentist assignment.
How does a member reassign to a different Delta Dental dentist?
The letter received upon enrollment gives instructions on how to change to a different Delta Dental dentists, if necessary. The best way is to call our call center using Delta Dental's dedicated Wellcare custom phone line at 855-643-8515.
What if I am a dentist in the Delta Dental Medi-Medi network but do not fully understand how the Wellcare D-SNP dental plan and the Medi-Cal dental plan works for the member? Where can I get help?
Contact Delta Dental directly at 855-643-8515 for more information.
What if I am a dentist under the Medi-Cal dental program but do not fully understand how the Wellcare D-SNP dental plan works for the member? Where can I get help?
Contact Delta Dental directly at 855-643-8515 for more information.
Can a Delta Dental contracted dentist turn away a Wellcare D-SNP member if they are not a Medi-Cal provider/dentist?
All dentists contracted under the Delta Dental Medi-Medi network are verified to be participating in the Medi-Cal dental Fee for Service network.
Who is the Primary Payer?
There is NO "primary" payer! The members have two plans with different benefits that do not coordinate with each other.
What if the member has Medi-Cal and D-SNP Covered Services on the same visit?
Two (2) claims are needed – One to Medi-Cal dental for Medi-Cal covered services, and a second claim to Delta Dental for the D-SNP plan covered services.
How does a dentist become part of the Delta Dental network and provide covered benefits on the D-SNP plan?
Visit the Delta Dental website to learn more about how to be a part of the Delta Dental Medicare network.
What is Care Coordination?
Care coordination is the organization of a member’s care across multiple health care providers to ensure the member receives safe, effective and appropriate care.
How is Care Coordination delivered?
A care coordinator collaborates with the member, the Health Plan, and the member's healthcare providers to ensure the member receives the necessary care. They work with the member to create a care plan and identify the team members responsible for delivering, coordinating, and overseeing the member's healthcare.
As a provider, what is my role in helping a member get access to Care Management or Care Coordination?
You can help the member receive Care Coordination or clinical case management in one of three ways:
- Submit an online request through the Provider Portal.
- Call the Wellness Case Management/Care Coordination Team at 833-340-0083 (Monday-Friday 5:00 a.m.-5:00 p.m. Pacific time).
- Email CenteneCMEscalationsMedicare@centene.com
How do providers refer members to access Care Management and Disease Management Programs or receive more information about these programs?
You can help the member receive Care Coordination or clinical case management in one of three ways:
- Submit an online request through the Provider Portal.
- Call the Wellness Case Management/Care Coordination Team at 833-340-0083 (Monday-Friday 5:00 a.m.-5:00 p.m. Pacific time).
- Email CenteneCMEscalationsMedicare@centene.com
Can a member self-refer for a care coordination?
Yes, Members may self-refer by calling the Care Management toll-free line at 833-340-0083.
What are the election period changes related to Duals for 2025?
The Centers for Medicare & Medicaid Services (CMS) is focusing on aligning the D-SNP and Medi-Cal/Medicaid Plan under the same parent organization for ease of care coordination.
- No quarterly Duals SEP effective January 1, 2025
- Two new monthly SEPs effective January 1, 2025
- SEP # 1 (Duals disenrollment) – Low Income Subsidy (LIS)/Dual Eligible (DE) members may enroll into Prescription Drug Plan (PDP) standalone disenrolling them from an MA or D-SNP plan; returning to original Medicare/FFS.
- SEP # 2 (Integrated care) – LIS/Dual Eligible (DE) members may move/enroll into an integrated D-SNP plan IF they are already enrolled or are in the process of enrolling into the same parent organization’s Medi-Cal plan.
Here are the counties that Wellcare has the integrated plans: Fresno, Kings, Madera, Los Angeles, Sacramento, and Tulare.
What integrated DSNP plan does Wellcare By Health Net have?
- Wellcare Dual Align – Wellcare By Health Net D-SNP with a Health Net Medi-Cal plan in Los Angeles, Sacramento, and Tulare.
- Wellcare CalViva Health Dual Align* – Wellcare By Health Net D-SNP with a CalViva Health Medi-Cal plan in Fresno, Kings, and Madera counties.
* CalViva Health is a Medi-Cal Managed Care Plan (MCP) and is the Local Initiative Health Plan for Medi-Cal managed care in Fresno, Kings, and Madera Counties. CalViva Health is a full-service health plan contracting with the Department of Health Care Services (DHCS) to provide Medi-Cal Covered Services to Medi-Cal managed care enrollees under the Two-Plan model in all zip codes in Fresno, Kings, and Madera Counties. CalViva Health contracts with Health Net Community Solutions, Inc. on a capitated basis to provide and arrange for Medi-Cal Covered Services in all zip codes in Fresno, Kings, and Madera Counties. Health Net Community Solutions, Inc. is a subsidiary of Health Net, LLC and Centene Corporation, and is the CalViva Health MCP’s Contracted Administrator in all zip codes in Fresno, Kings, and Madera Counties.
How can I help a patient enroll in one of the Wellcare By Health Net's D-SNP plan?
You can help the patient enroll into one of the Wellcare By Health Net's D-SNP plan by referring the patient to our enrollment website or to call the Medicare Advantage enrollment phone number (844) 997-3879 (TTY 711) 7 days a week between 8:00 a.m. and 8:00 p.m..
Who is CalViva Health?
CalViva Health is a Medi-Cal Managed Care Plan not affiliated with or owned by Centene. They are the Local Initiative Health Plan for Medi-Cal managed care in Fresno, Kings, and Madera counties (Central Valley). CalViva Health is a full-service health plan contracting with DHCS to provide Medi-Cal Covered Services to Medi-Cal managed care enrollees under the Two-Plan model in all zip codes in Fresno, Kings, and Madera counties. CalViva Health contracts with Health Net Community Solutions, Inc. on a capitated basis to provide and arrange for Medi-Cal Covered Services in all Zip Codes in Fresno, Kings, and Madera counties.
Why are Wellcare By Health Net and CalViva Health working together?
To meet the goals of the CalAIM Program, CA Medi-Cal plans will be required to also have a Medicare Advantage D-SNP Plan. CalViva Health only has the Medi-Cal contract with the state and does not have any Medicare contracts with CMS. Since Health Net’s parent organization, Centene, has a Medicare Contract, CalViva Health and Wellcare By Health Net have partnered to provide an Exclusive Aligned Enrollment D-SNP plan in Fresno, Kings and Madera counties.
How does the partnership between Wellcare By Health Net and CalViva Health benefit the members in Fresno, Kings, and Madera counties?
It allows for member care coordination. When a dual eligible beneficiary joins the Wellcare By Health Net D-SNP plan in Fresno, Kings, and Madera counties, they will be automatically assigned to CalViva Health for their Medi-Cal Managed Care Plan.
Where do I direct a patient who wants to enroll, leave or change to a different D-SNP plan?
The patient can contact their broker, Member Services or 800-MEDICARE (800-633-4227).
- For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
- For D-SNP members in all the other counties, call 800-431-9007
What happens if a member loses their Medicaid/Medi-Cal eligibility?
If a D-SNP member loses their Medicaid/Medi-Cal eligibility, they can remain on the D-SNP for a period of time (called "deeming period") giving them opportunity to regain their Medicaid/Medi-Cal eligibility. If they do not regain their Medicaid/Medi-Cal eligibility, they are involuntarily disenrolled from the D-SNP plan. Wellcare By Health Net members have a 6-month deeming period.
What is the DHCS matching plan policy?
For dual eligible beneficiaries who choose to enroll in a Medicare Advantage (MA) plan in those counties, their Medi-Cal plan must align with their MA plan choice, if there is a Medi-Cal plan affiliated with their MA plan. The Medi-Cal matching plan policy does not change or impact a beneficiary's MA plan choice.
Please refer to the DHCS website's Medi-Cal Matching Plan Policy for Dual Eligible Beneficiaries.
How is Enhanced Care Management (ECM) different from the D-SNP model of care?
There is significant overlap across the D-SNP model of care and ECM requirements which could result in duplication and confusion for members and care teams if a member receives care management from both programs. In summary, D-SNP members are not eligible for ECM. For more information on ECM and how it differs from D-SNP, refer to the DHCS CalAIM policy guide (PDF) and the ECM policy guide (PDF).
When and how will members/beneficiaries be made aware of plan or benefit changes for the coming new plan year?
Members will be notified of the new plan year changes by mail via the Annual Notification of Changes (ANOC) in September and/or the standard non-renewal notice sent in October.
The Annual Notification of Change will outline specific changes in benefits between the current year and the next plan year.
Advise your patients to ensure their Medicare plan has their current address and phone number so they receive the information.
As a contracted provider, how will Wellcare By Health Net let me know about general updates throughout the year?
Providers will receive communications throughout the year as needed, such as service areas expansion, plan name changes, new vendors for member supplemental benefits and more. Providers are also encouraged to access the D-SNP Resources for Providers page online for the most current resources and updates, as the page is updated regularly.
What benefits do D-SNP members have access to under Medi-Cal Benefit?
The Medi-Cal benefit includes: Long Term Care (LTC), Community Based Adult Services (CBAS), Community Supports, Durable Medical Equipment (DME), and Medi-Cal covered transportation.
The Community Resource/Supports may include, but is not limited to, the following services:
- Housing Transition Navigation Services (homeless, or about to become)
- Housing Deposits
- Housing Tenancy and Sustaining Services
- Short-Term Post Hospitalization Housing
- Recuperative Care (medical respite)
- Respite Services
- Day Rehabilitation
- Nursing Facility Transition/Diversion to Assisted Living Facilities
- Community Transition Services/Nursing Facility Transitions to a Home
- Personal Care and Homemaker Services
- Environmental Accessibility Adaptations (home modifications)
- Meals/Medically Tailored Meals
- Sobering Centers
- Asthma Remediation
How does the member access Medi-Cal covered benefits?
You can help the member in any of these ways below:
- Providers can submit a request for a care coordination through the Provider Portal.
- Providers can use the findhelp platform to submit referrals to request Community Support benefits.
- Providers can contact our Care Management team by calling the phone number 833-340-0083 or sending an email to help_referral@healthnet.com.
- Providers can advise the member to contact the Member Services number in the back of the card