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.
Join Our Provider Network
Not a Wellcare By Meridian Provider? Complete our “Join Our Network” form to begin the contracting process.
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
- APA Work Group on Psychiatric Evaluation
- Illinois Department of Human Services Community Reintegration Program
- American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality issues, Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care
- Clinical Practice and Preventive Health Guidelines
Your practice is participating in the Meridian Integrated Duals Plan, effective January 1, 2026.
Use our Prior Authorization tool to check if prior authorization is required for a member’s service or procedure.
Special Supplemental Benefits for the Chronically Ill (SSBCI) can be offered to Medicare Advantage (MA) members who have one or more complex chronic conditions, are at high risk for hospitalization or adverse health outcomes and require intensive care coordination. SSBCI aims to improve overall health outcomes for the chronically ill population by addressing social needs beyond traditional medical care such as food, housing, transportation, and gaps in care. The program is designed to support individuals by offering additional services beyond standard Medicare coverage.
Members must qualify for SSBCI benefits
Members must meet all three criteria to qualify:
- The member must require intensive care management.
- The member must have a history of frequent outpatient services or specialty care and/or, evidence of poor disease control or medication adherence and/or, social or behavioral factors impacting health outcomes.
- The member must be at high risk for unplanned hospitalization.
- The member must have a history of frequent hospitalizations or ED visits related to the chronic condition.
- The member must have a documented and active diagnosis for a qualifying chronic condition.
- The chronic condition must be life threatening or significantly limit the overall health or function of the member.
How to Determine Eligibility
Auto Eligibility Process: We utilize internal and claims data in our internal algorithm to identify members that meet the three criteria. This automatic process refreshes weekly, and links member data across time and health plans, enabling a comprehensive view of historical claims. This process includes all members enrolled in an SSBCI-eligible plan.
Manual Eligibility Process: We may not have claims data or medical records for new members early in the year. These members can go through the manual process to have a provider attest to their eligibility.
To begin the SSBCI manual eligibility process, members must schedule an in-person office visit or contact their healthcare provider to request the attestation be completed. If an office visit is required to complete the attestation, the provider will evaluate the member’s health status during the visit and determine if they meet SSBCI criteria.
Provider Instructions for SSBCI Attestation
Providers should follow these steps to complete the attestation:
- Visit ssbci.rrd.com.
- Review the eligibility criteria outlined on the site (see criteria above) and evaluate the member accordingly.
- Submit an attestation through the website confirming the member meets SSBCI eligibility requirements.
- Submit a claim from the office visit that includes the appropriate diagnosis codes indicating the member has one or more What Happens Next?qualifying chronic conditions listed on ssbci.rrd.com.
What Happens Next?
Once the attestation is received:
- The member will receive an approval or denial letter within 10 business days.
- If approved, the letter will include details about the specific SSBCI benefits available and instructions on how to access them.
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 are training options with links to booklets and modules.
New Provider Orientation
Mandatory Training Attestation
If you have already completed this mandatory training with another health plan, please fill out the form below and return to Wellcare By Meridian via one of the following methods:
Fax: 1-833-560-2915
Email: ilproviderrelations@mhplan.com
Mail:
Wellcare By Meridian
Network Development - Attestation
1333 Burr Ridge Parkway, Suite 500
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 that contract with Wellcare By Meridian to provide care for members under the Integrated Care Program contracts.
Critical Incidents Training
Our Critical Incidents Training teaches providers how to recognize and report instances of abuse and neglect of 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 Wellcare By Meridian healthcare services they receive.
For revisions to the Medicare Benefit Policy Manual, frequently asked questions and their responses, please visit the Centers for Medicare and Medicare website.
We’re committed to supporting our providers through regularly scheduled training opportunities.
Learn about upcoming webinars and training opportunities.