UnitedHealthcare and WellMed Medical Management have an affiliation through which WellMed manages certain administrative services for UnitedHealthcare Medicare Advantage plans in select states. However, WellMed operates as a separate company from UnitedHealthcare with its own provider network and clinical services.
Below we’ll explain the relationship between WellMed and UnitedHealthcare, how they collaborate on Medicare Advantage plans, and what this means for providers and health plan members.
Overview of WellMed
WellMed Medical Management is an independent physician-led population health management company based in San Antonio, Texas. WellMed was founded in 1993 by a group of physicians seeking to improve senior care.
Here are some key facts about WellMed:
- Operates 36 medical clinics across Texas and Florida
- Has over 700 primary care providers and specialists in its network
- Serves over 240,000 patients, most are seniors enrolled in Medicare Advantage
- Ranked among largest medical groups in the U.S. by Medical Group Management Association
- Known for physician-led care teams and patient-centered approach
In addition to operating medical clinics, WellMed has management services contracts with UnitedHealthcare and other insurers to provide administrative support for Medicare Advantage plans.
WellMed maintains its own separate provider network, clinical protocols, and care management approach across its medical clinics. But it collaborates with insurers on the administrative side to better coordinate coverage and care for health plan members.
Relationship Between WellMed and UnitedHealthcare
UnitedHealthcare is a nationwide health insurance company offering employer-sponsored plans, individual health coverage, Medicare plans, Medicaid plans, and specialty benefits.
WellMed and UnitedHealthcare have an affiliation through which WellMed provides certain administrative services for UnitedHealthcare Medicare Advantage members in selected markets. WellMed does not own or manage UnitedHealthcare’s Medicare Advantage insurance plans.
Here is an overview of how WellMed and UnitedHealthcare work together:
Administrative Services Contract: WellMed has agreements with UnitedHealthcare to handle administrative functions for certain Medicare Advantage plans in Florida and Texas.
Limited Service Areas: WellMed administers UnitedHealthcare plans for members residing in parts of Texas and Florida where WellMed operates medical clinics.
Separate Provider Networks: WellMed has its own contracted provider network separate from UnitedHealthcare’s national Medicare Advantage network.
Shared Members: Medicare beneficiaries can enroll in UnitedHealthcare plans for which WellMed provides administrative support and receive care from both WellMed clinic providers and other UnitedHealthcare Medicare Advantage network providers.
UnitedHealthcare Oversight: UnitedHealthcare Medicare Advantage maintains responsibility for overall functions like enrollment, claims payments, customer service, and compliance. WellMed focuses mainly on front-end administrative tasks.
So in essence, WellMed serves as a third-party delegated administrator handling certain administrative functions for UnitedHealthcare Medicare Advantage members in select geographic areas.
WellMed’s Role With UnitedHealthcare Medicare Advantage Plans
As UnitedHealthcare’s delegated administrator, WellMed manages the following administrative responsibilities on behalf of certain UnitedHealthcare Medicare Advantage plans in Texas and Florida:
- Submission and processing of claims
- Claims payment reviews and reconsiderations
- Prior authorization requests
- Hospital admission notifications
- Referral requests and coordination
- Utilization management
- Quality of care reviews
Under its administrative services contracts, WellMed also provides UnitedHealthcare with network management, care coordination, and other support services for the delegated Medicare Advantage plans.
However, UnitedHealthcare Medicare Advantage still oversees key areas like health plan enrollments, membership materials, customer service, claims reimbursement, and compliance with CMS regulations.
How Providers Identify the Relationship
To determine whether WellMed is managing administrative services for a UnitedHealthcare Medicare Advantage member, providers should check the following:
Member ID Card – Cards will display WellMed’s payer ID and contact information if they are the delegated administrator. Cards without WellMed listed means UnitedHealthcare administers the plan directly.
Eligibility Checks – When verifying eligibility electronically or through UnitedHealthcare’s provider portal, you can identify whether WellMed is the delegated administrator.
Referrals – If the member’s plan requires referrals or authorizations, these may need to be submitted to WellMed based on who administers that member’s health plan.
Confirming which entity – WellMed or UnitedHealthcare – is responsible for administrative functions allows providers to correctly submit claims, authorization requests, and admission notifications to the appropriate party.
How Does This Impact Providers?
As a healthcare provider treating UnitedHealthcare Medicare Advantage members, there are a few important things to note regarding the WellMed affiliation:
You may see patients covered under UnitedHealthcare plans administered by WellMed rather than UnitedHealthcare directly.
You’ll need to follow WellMed’s procedures for claims, authorizations, and admissions for these patients rather than UnitedHealthcare’s standard processes.
WellMed has its own provider network – you’ll need to be contracted with them separately to be considered in-network for plans where WellMed handles administrative duties.
Patient care, coordination, and population health programs for members may be managed by WellMed rather than UnitedHealthcare.
For UnitedHealthcare plans not administered by WellMed, you’ll interact directly with UnitedHealthcare as normal.
The WellMed-UnitedHealthcare arrangement does lead to some nuances in processes and which entity providers collaborate with. But overall it is aimed at better coordinating coverage and care for Medicare Advantage members.
Is WellMed Only Affiliated With UnitedHealthcare?
No, WellMed has administrative services contracts and collaborations with several major health insurance companies beyond just UnitedHealthcare. These include:
Humana – WellMed provides administrative services for Humana Medicare Advantage HMO members in certain Florida and Texas counties.
Blue Cross Blue Shield of Texas – WellMed administers Blue Cross Medicare Advantage PPO plans in Texas.
Cigna – WellMed provides administrative services for Cigna-HealthSpring Preferred Medicare (HMO) plans in parts of Houston and Corpus Christi, Texas.
So while WellMed has an extensive relationship with UnitedHealthcare, it also partners with other insurers to manage Medicare Advantage member administration in its Texas and Florida markets.
Benefits of the WellMed and UnitedHealthcare Collaboration
The main benefits of WellMed’s role as administrative service provider for UnitedHealthcare Medicare Advantage plans include:
Local Market Expertise – WellMed has on-the-ground provider networks and expertise in its core Texas and Florida markets. This can enhance coordination for UnitedHealthcare members in these areas.
Network Access – Broader provider access for UnitedHealthcare Medicare Advantage members between WellMed’s own network and UnitedHealthcare’s national Medicare Advantage network.
Aligned Incentives – As a physician-led organization, WellMed shares UnitedHealthcare’s incentives around quality of care, controlled costs, and population health management.
Person-Centered Care Model – WellMed’s focus on compassionate senior care matches UnitedHealthcare’s emphasis on the patient experience and engagement.
Administrative Efficiency – WellMed’s management of key administrative functions may enable more efficient operations in certain markets.
The alliance aims to leverage the capabilities of both companies to better serve UnitedHealthcare Medicare Advantage members.
WellMed Medical Management is an independent physician-led medical group and population health management company
WellMed has an affiliation with UnitedHealthcare to provide administrative services for select Medicare Advantage plans in Texas and Florida
WellMed maintains its own separate provider network and care models across its medical clinics
UnitedHealthcare Medicare Advantage oversees health plan operations and retains ultimate responsibility
Providers should verify if WellMed administers a UnitedHealthcare patient’s plan to follow proper protocols
WellMed has similar arrangements to manage plans for other major insurers besides just UnitedHealthcare
While legally separate companies, the alignment between WellMed and UnitedHealthcare strives to enhance administrative efficiencies and care coordination for Medicare Advantage members.
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