December 6, 2024
New template applies to Wellcare Medicare Advantage HMO
Independent practice associations (IPAs) must use the updated letter template to notify members of specialist terminations. The updated template is approved by the Centers for Medicare & Medicaid Services.
Download the template
Download the template at www.wellcare.com/California > Providers > Medicare > Overview > California Provider Resources.
Use the template that corresponds to the H-contract number for the product indicated in the chart below. The H-contract number is shown in the template’s footer and in the name of file available for download at www.wellcare.com.
| Template | H-Contract | Product |
| Medicare Provider Termination Notification Template-MA H5087 |
H-5087 |
Medicare Advantage |
Additional information
Relevant sections of the Wellcare Provider Manual have been revised to reflect the information contained in this update as applicable. The manual is available online www.wellcare.com/California/Providers/Medicare.
If you have questions regarding the information contained in this update, contact 1-866-999-3945.
