WellMed Medical Management, Inc., WellMed Network, Inc. (WNI) and WellMed Networks of Florida, Inc. (WNFI) are delegated medical groups that contract with Medicare Advantage health plans and assume and perform some functions on behalf of the health plan such as prior authorizations, claims payment, care coordination and network management. The health plan is the insurance company that pays for its members’ health care costs. WellMed is the care delivery medical group that provides medical care to patients. Some WellMed patients have WellMed on their insurance cards because WellMed is the insurance plan member’s assigned physician and medical group within the health plan provider network.

Open panels vary by provider and network availability. You can check panel status by searching the provider directory at Find Doctors Near You – WellMed (Opens in new window).

Owned/Employed providers are employed by WellMed Medical Group or Optum and work in a WellMed or Optum branded clinic.

Contracted providers are independent medical providers who own their own practices but contract with WellMed Network, Inc. (WNI) or WellMed Networks of Florida, Inc. (WNFI) to provide value based care but is not employed by WellMed. Both employed clinic providers and external groups can be part of the WellMed Network.

Contracted providers are part of the WellMed or Optum provider network giving them the ability to accept patients with select Medicare Advantage health plans through the WellMed and Optum contracts with the health plan. Additionally, contracted providers receive administrative support from WellMed Medical Management, Inc. to help deliver value-based care to their patients. Services may include but are not limited to, quality and disease management and patient engagement programs.

WellMed Network, Inc. (WNI) and/or WellMed Networks of Florida, Inc. (WNFI) may contact delegated plan members based on health plan assignment or delegated responsibility with the health plan. Even if a member is not actively seen at a WellMed or Optum branded clinic, WellMed Network, Inc. (WNI) or WellMed Networks of Florida, Inc. (WNFI) may manage certain care coordination or outreach programs under its contractual agreement with the member’s health plan. Based on this, we may support a contracted or independent physician with the management of that person’s care.

While WellMed is not a health insurance plan and should not be referred to as such, WellMed Network, Inc. (WNI) and WellMed Networks of Florida, Inc. (WNFI) contract directly with several Medicare Advantage health plans and manages the medical risk for those health plan members who are a contracted or affiliated provider’s patient. Contracted and affiliated providers can have a contract with WellMed Network, Inc. (WNI) or WellMed Networks of Florida, Inc. (WNFI) and accept members under their contract and also have a direct contract with other health plans and not own any risk, however, they can not have both for those same health plan members.

Providers may not populate in the provider directory and/or enrollment tools (Jarvis, Sunfire, HealthSpring, UHC, etc.) if their credentialing or contract information has not been updated in the system. Please share all details with the local Growth team member in your respective market. Contact information can be found within the Broker Information Center (WellMed/Optum Broker Information Center (Opens in new window)).

The primary care provider (PCP) is responsible for submitting an electronic referral through the WellMed online platforms. Once received, the specialist office will contact the patient to schedule an appointment. Referrals and authorizations would follow the health plan’s process, not WellMed’s process for managing medical risk. Always confirm if the provider is part of the WellMed provider network for specific health plans before scheduling.

While PPO plans generally allow direct access to specialists, some specialists or delegated groups (like WellMed) may require a referral to ensure care coordination and coverage verification. This helps prevent out-of-network charges and ensures medical necessity is documented.

If pending, confirm whether clinical documentation has been submitted. If approved, contact the specialist’s office to confirm scheduling.

Ask your client to provide a copy of the bill. Verify that the referral and authorization were in place at the time of service (if required). If an error is confirmed, our provider services department can research this further. Please contact the Broker Helpline for further support at 866-970-4585 from 7am to 6pm CST and share all details.

Chronic condition verification must be reviewed annually or shortly after being enrolled in a Chronic Special Needs Plan (CSNP) to confirm the chronic condition diagnosis. If not completed, confirm whether the PCP has submitted the necessary documentation or if the patient needs a follow-up visit to verify the condition. For assistance, you can contact the clinic directly or call the Broker Helpline at 866-970-4585 from 7am to 6pm CST.

Your client can either contact the clinic directly or the agent/broker (when with the patient) can call the Broker Helpline at 866-970-4585 from 7am to 6pm CST. Additionally, the patient can request an appointment at Request an Appointment – WellMed. If additional support is needed, please contact your local Growth team member. Contact information can be found within the Broker Information Center (WellMed/Optum Broker Information Center (Opens in new window)).

There are two ways to schedule a tour. You can call the Broker Helpline directly to schedule a tour for your client at 866-970-4585 from 7am to 6pm CST. Or your client can request a tour at the following link: Request a clinic tour – WellMed Medical Group.

If you have questions, comments, concerns or suggestions, please contact a member of our local Growth team. Access the Broker Information Center (WellMed/Optum Broker Information Center (Opens in new window)), navigate to your respective market, where you will find the Growth team members and contact information.

Various collateral materials and information can be found within the Broker Information Center at WellMed/Optum Broker Information Center (Opens in new window).

To contact a member of our local Growth team, access the Broker Information Center (WellMed/Optum Broker Information Center (Opens in new window)), navigate to your respective market, where you will find the Growth team members and contact information.