Due to the current government shutdown, we want to let you know that updates to your Medicare account may take longer than usual. Learn more about how this may affect your services.
Wellcare By Meridian Providers
Thank you for being a trusted partner in care. We’re dedicated to working alongside you to ensure your patients receive the highest quality care.
On our site, you’ll find a range of helpful resources including key documents and forms, clinical guidelines, news and other updates, and more.
Join Our Provider Network
Not a Wellcare By Meridian Provider? Complete our “Join Our Network” form to begin the contracting process.
Provider Resources
Wellcare By Meridian encourages the use of evidence-based Clinical Practice Guidelines (CPGs) by our providers. Our Quality Improvement Committee approves and adopts CPGs for prevention, diagnosis, and management of medical and behavioral health conditions. These guidelines are developed by nationally-recognized sources for the provision of acute, chronic, and behavioral health services relevant to populations served.
Wellcare By Meridian promotes implementation of these CPGs via dissemination among practitioners and uses numerous performance measures to provide feedback to achieve consistent and high-quality health outcomes for our members. CPGs are reviewed annually and updated as necessary by the Meridian Physician Advisory Committee (PAC) and approved by the Quality Improvement Committee and Board of Directors.
Medical Guidelines
These CPGs are the basis for our Disease Management and Behavioral Health programs.
- Behavioral Health Guidelines
- Clinical Practice and Preventive Health Guidelines
Your practice is participating in the Meridian Integrated Duals Plan, effective January 1, 2026.
Advance Directives Information - English (PDF) - Coming Soon
Access Medicare Necessity Criteria.
Provider Training, Orientation, and Webinars
Wellcare By Meridian follows CMS guidelines to deliver the appropriate educational pieces to its provider network. Together, we will achieve outstanding quality and increased value in the care provided to our members. Below you'll see which training is required for your plan along with links to the training booklets and training modules.
Mandatory Training Attestation
If you have already completed this mandatory training with another health plan, please fill out the form below and return to Meridian via one of the following methods:
Fax: 1-833-560-2915
Email: ilproviderrelations@mhplan.com
Mail:
Meridian
Network Development - Attestation
1333 Burr Ridge Parkway, Suite 100
Burr Ridge, IL 60527
Fraud, Waste, and Abuse (FWA)
Our FWA overview assists providers participating in FWA prevention and detection. Providers required to complete training: All contracted Medicare providers.
Cultural Competency/ADA Training
Our Cultural Competency Training provides important information to support providers in caring for our Members.
Providers required to complete this training: All providers intending to contract with Meridian to provide care for Members under the Integrated Care Program and/or MMAI contracts.
Cultural Competency Training
- Cultural Competency Module (PDF)
- Cultural Competency Training Booklet (PDF)
- Cultural Competency Resources (PDF)
Critical Incidents Training
Our Critical Incidents Training teaches providers how to recognize and report instances of abuse and neglect of Meridian Members.
Providers required to complete training: All contracted providers.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
CAHPS surveys help members provide feedback on a variety of Meridian healthcare services they receive.
Jimmo v. Sebelius Information
On January 24, 2013, the U.S District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius. The settlement clarifies skilled care delivery for skilled nursing facilities (SNFs), home health (HH), inpatient rehabilitation (IRFs), and outpatient therapy (OPT) benefits. The Centers for Medicare and Medicaid Services (CMS) has instructed Medicare insurers like Meridian Health Plan to convey this information to our providers to ensure that services are provided and coverage determinations are adjudicated accurately and appropriately in accordance with associated policy.
For documentation requirements, revisions to relevant portions of the Medicare Benefit Policy Manual, frequently asked questions and their responses, please visit the CMS website or review the following materials below:
We’re committed to supporting our providers through regularly scheduled training opportunities.
Learn about upcoming webinars and training opportunities.
Questions? Contact Us