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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 Manual
    An extension of the Participation Agreement and a resource that provides guidelines on health plan coverage procedures, policies and other information related to the provision of health care services to our members.  This document should be used simultaneously with the Quick Reference Guide and other reference resources. 
    'Ohana Medicare Advantage Manual
    'Ohana Medicaid Manual
     

 

 

  • 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. 

 

 

 

  • 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. 

 

All links associated in the section above require the ability to open .pdf files. If for any reason you are not able to view these links, pleasedownload the reader software


Last modified: 12/21/2011

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