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Important Network Updates & Enhancements

Cristal Gonzalez
Provider Alerts

From: WelbeHealth
To: Health Plan Providers
Type: Informational
Subject: Important Network Updates & Enhancements
Business: PACE
State(s): PACE – California

We are excited to share several important updates to support your work and streamline your interactions with WelbeHealth:

1. Reminder: Claims Submission Updates Effective 10/01/25
Action Required: Update your systems immediately to avoid delays.

  • We no longer accept paper claim submissions – Do not send claims/disputes/ correspondence to PO BOX 30760, Tampa, FL 33630-3760
  • Submit electronic claims (no attachments):
  • Claims with documentation should be faxed to (626) 209-4367
  • Provider Disputes & Correspondence should be faxed to (626) 498-2099 with proper forms and documentation for each.

2. New Claims Payment Schedule – Effective Week of Nov 3, 2025
To improve the timeliness of claims payments:

  • We will conduct two check runs per week: Tuesdays & Fridays
  • Schedule adjusted if a holiday falls on these days

3. New IVR System – Live 09/22/25
Our Interactive Voice Response (IVR) system reduces wait times and helps you:

  • Get authorization details
    Check claim status
    Verify participant eligibility
    Reduce hold times

Try our new IVR System by calling us at (650) 336-0300.

4. Provider Manual has been updated and is Live on our website!
Access the updated manual on our website: https://welbehealth.com/partners/

5. New Participant ID Cards
New cards were mailed to all participants.
Action Required: Request an updated ID card during visits and ensure your billing systems reflect the updated information for accurate claims submission and processing.

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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

Seasonal Health Tips for Seniors

Cristal Gonzalez
Seasonal Health Tips for Seniors
Resources

As fall and winter arrive, seniors face new health challenges because of cooler temperatures, shorter days, and an increased risk of seasonal illnesses. Being prepared for these changes can help seniors stay healthy, safe, and comfortable during the colder months.

Exciting News: More Flexibility for External Specialist Services!

Cristal Gonzalez
Provider Alerts

From: WelbeHealth
To: Health Plan Providers
Type: Informational
Subject: Effectuation of Care (EOC) – Specialist Flexibility
Business: PACE
State(s): PACE – California

Dear Valued Provider,
WelbeHealth is excited to share an update that makes working with us easier while ensuring timely access to care for our participants.

What’s Changing?
Specialists now have the clinical oversight to provide additional services during an existing appointment. These services may be performed or scheduled at the same or a follow-up visit if not on the Prior Authorization (PA) List.

Specialist Definition: A specialist is a licensed healthcare professional with advanced training in a specific area of medicine or behavioral health who provides evaluation, diagnosis, or treatment services outside the participant’s primary care setting.

Please Note – Exceptions:
• Laboratory Services (including blood draws, urine testing, pathology, etc.) – excluded from this process and must continue to follow existing workflows.
• Dental specialists – Managed separately under the Dental process.

Key Reminders
• Initial Orders: All services must start with a WelbeHealth order; specialists cannot initiate the first order.
• Prior Authorization:
o Services not on the PA List do not require PA when delivered during external specialist visits.
o Services on the PA List must follow our standard PA process:
•  PA List: welbehealth.com/partners
• Submit requests via QuickCap Provider Portal (preferred) or fax the Authorization Request Form to (209) 729-5854.

• Medical Records: Case notes must be submitted within five (5) days of the Date of Service.

Why This Matters?
• Less administrative burden
• Expanded access to services
• Stronger collaboration between providers and WelbeHealth

WelbeHealth Provider Partnership Department

___________________________________________________________________________________

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