ALC - welbe

test

Pilot: Riverside and San Bernardino Networks | Improved WelbeHealth Referral Forms

Cristal Gonzalez
Provider Alerts

From: WelbeHealth
To: Health Plan Providers
Type: Informational
Subject: Improved WelbeHealth Referral Forms
Business: PACE
State(s): PACE – California

Pilot: Riverside and San Bernardino Networks | Improved WelbeHealth Referral Forms – Designed with Your Feedback

WE HEARD YOU

Dear WelbeHealth Contracted Providers,

As we approach the close of 2025, the WelbeHealth team is pleased to share updates to our Referral Forms, designed to make your experience smoother and more efficient.

Based on your feedback, we have refined the forms to improve navigation and visibility of key information, helping you quickly identify what you need and streamline the referral process.

These enhancements reflect valuable insights from our contracted providers. Our goal is to create a more user-friendly experience and better support your success in partnering with WelbeHealth.

We welcome your continued feedback to help us strengthen the way we work together. If you have questions or suggestions regarding the updated referral forms, please reach out to your Provider Partnership Associate directly or contact us at providers@welbehealth.com.

Thank you for your ongoing commitment to delivering exceptional care to our Participants. We truly appreciate all that you and your team do every day.

Thank you for being a valued partner.

Warm regards,

The WelbeHealth Team

______________________________________________________________________________________________________________

If you have any questions, please contact your Provider Partnership Representative, or email the Provider Partnership team at providers@welbehealth.com. You may also visit welbehealth.com/partners for online access to this document and all other WelbeHealth Provider Alerts

Claims Timely Payments

Cristal Gonzalez
Provider Alerts

From: WelbeHealth
To: Health Plan Providers
Type: Informational
Subject: Change – Claims Processing
Business: PACE
State(s): PACE – California

Claims Timely Payments

Beginning January 1, 2026, the Department of Health Care Services (DHCS) will implement a new process for timely processing of claims. Assembly Bill 3275 states, upon receipt of a Complete Claim, payment or denial will be made within thirty (30) calendar days. WelbeHealth shall notify Providers in writing no later than thirty (30) calendar days after receipt of a claim. If a claim or a portion is contested (denied), the notice will identify the specific reason WelbeHealth is contesting (denying) the claim.

If an uncontested (paid) claim is not reimbursed by delivery to the provider’s address of record within 30 calendar days after receipt, interest accrues at 15% per annum, beginning with the first calendar day after the 30-calendar day period. If the interest payment is not included in the claim payment, WelbeHealth pays the provider an additional fifteen dollars ($15) or ten percent (10%) of the accrued interest on the claim.

The requirement for interest and penalty applies to all claims, including claims for emergency services and care.

Claim Timely Filing Limits

Effective January 1, 2026, corrected claims and correspondence claims submission time frames have changed to the following:

Clean Claims
The term listed in your agreement, or 365 days from the Date of Service

Corrected Claim
180 days from the Date of Service unless the original claim was denied, then 180 days from the Remittance Advice (RA)

Correspondence
180 days from the date of the Remittance Advice (RA)

Provider Dispute (PDR)
The term listed in your agreement or, 365 days from the date of action/inaction

______________________________________________________________________________________________________________

If you have any questions, please contact your Provider Partnership Representative, or email the Provider Partnership team at providers@welbehealth.com. You may also visit welbehealth.com/partners for online access to this document and all other WelbeHealth Provider Alerts