Provider : Resources

The resources below will assist you in working with 'Ohana Health Plan ('Ohana).  Click on the links below to access more information.  Please note:  the materials accessed online are the most current and up-to-date available.   
If you have a question and you cannot find the answer, don’t hesitate to submit that requests to us via our online form.  

 

• Provider Quick Reference Guides
  Provide 'Ohana contact information and authorization guidelines.
  'Ohana Medicare Advantage QRG
  'Ohana Medicaid QRG  

 

• Provider Forms and Documents
  Template forms and documents for appeals, authorizations, claims, pharmacy services and more.
  'Ohana Medicare Advantage Forms and Documents
  'Ohana Medicaid Forms and Documents

 

• Clinical Coverage Guidelines  (You will be redirected to our corporate website.)
  Evidence-based guidelines detailing the medical necessity of, and sets consistent criteria for coverage of, given procedures or technologies to ensure greater consistency and efficiency in clinical decision making.

 

• Clinical Practice Guidelines  (You will be redirected to our corporate website.)
  Best-practice guidelines used to guide efforts in improving the quality of care in our membership.  CPGs are based on available clinical outcome and scientific evidence-based content developed by expert professional and clinical society recommendations. 

 

• Provider Training and Education Materials
  Educational resources regarding initiatives that require specific actions by providers.  You must log in to access required Provider training.  Click here if you are not a registered user. 
  'Ohana Medicare Advantage Provider Education Materials (PEMs)
  'Ohana Medicaid Provider Education Materials (PEMs) 

 

• Provider Job Aids and Resource Guides
  Your one-stop-shop for resource documents and instructions on how to perform daily tasks with 'Ohana. 

 

• Claims Corner
  Provides updates on WellCare's claims processes, ensuring that provider claimsare handled efficiently.  

 

• Provider Newsletters
  Quarterly newsletters to provide current information on pharmaceuticals, cost and quality of care, to share tips on how to perform processes more efficiently with 'Ohana, and to highlight recent successes, such as accreditations and quality scores. 

 

• Long-Term Care Facilities Updates
  Please check this site regularly for important information for Long-Term Care Facilities.

Last modified: 12/21/2011