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Scope of Appointment (SOA) Process

For paper applications, producers have the option to document scope through the Appointment Verification Line (AVL) or a paper SOA. The below process must be followed for both options:

1. Obtain a compliant Consent to Contact
2. Obtain a compliant Scope of Appointment (SOA) NOTE: When possible, SOA should be captured prior to hosting a face-to-face appointment.
3. Host a compliant 1:1 appointment
4. If the beneficiary is prepared to enroll, determine if the application method will be paper or electronic.

  • Paper application: if an Appointment ID was not obtained by calling the AVL, a paper SOA form MUST be faxed with the paper application.
  • Electronic application: a call to the AVL is still required

If an enrollment is not completed at the time a paper SOA is obtained, the producer is responsible for storing that document compliantly. WellCare's AVL record is electronically maintained for 10 years and can be easily accessed via request.

Note: Producers will need to maintain their own records for Consent to Contact. Producers must document scope through WellCare's Appointment Verification Line (AVL) for all online applications.

PDP Appointment Verification Line: 1-877-297-3625

Only use this line if you are NOT in the following states:

AR, CT, FL, GA, HI , IL, KY, LA, MS, NJ, NY, SC, TN, TX

Coordinated Care Plans (CCP) AVL Numbers

Please use the appropriate number for your respective market: 
Monday - Sunday: 8 a.m. - 8 p.m., EST.

Market and Phone Number

Arkansas: 1-866-563-5134
Connecticut: 1-877-819-1157
Florida (East): 1-877-819-2980
Florida (South): 1-877-820-4938
Florida (West): 1-877-829-6303
Georgia (Central-SW): 1-877-819-1156
Georgia (North): 1-877-819-1155
Georgia (SE): 1-877-821-1519
Hawaii: 1-877-248-7509
Illinois: 1-877-819-2984
Kentucky:1-877-780-3896

Louisiana: 1-877-819-3239
Mississippi: 1-866-549-9476
New Jersey: 1-877-819-3247
New York (Upstate): 1-877-821-1528
New York (Downstate):1-877-819-1160
South Carolina: 1-866-561-9818
Tennessee: 1-866-563-2756
Texas (Dallas): 1-877-819-1159
Texas (Houston): 1-877-819-2982
Texas (San Antonio): 1-877-819-5830

Electronic Enrollment Verification Line (ePAV): 1-866-915-7670
Monday - Sunday: 8 a.m. - 2 a.m., Eastern.

Paper applications received by a sales agent must be faxed or mailed to WellCare within 48 hours of receipt.

Paper Application Fax: 

Coordinated Care Plans (CCP): 1-866-473-9124 
Prescription Drug Plans (PDP): 1-866-388-1521

Paper Application Mailing Address:

Coordinated Care Plans (CCP): PO Box 31392, Tampa FL 33631-3392
Prescription Drug Plans (PDP): PO Box 31411, Tampa FL 33631-3411

Special Populations (SPOP) Line for Medicaid verification: 1-866-211-0544
Monday - Friday: 8 a.m. - 9 p.m., EST
Saturday: 9 a.m. - 6 p.m., EST

Member Services

If you have a question about specific prospect or member, please reach out to our Member Services team.
Monday - Sunday: 8 a.m. - 8 p.m., EST
 
Market and Phone Number

PDP: 1-888-550-5252
Arkansas: 1-800-316-2273
Connecticut: 1-866-579-8006
Florida: 1-888-888-9355
Georgia: 1-866-334-7730
Hawaii: 1-888-505-1201
Illinois: 1-866-334-6876
Kentucky: 1-877-560-2766

Kentucky: 1-877-560-2766
Louisiana: 1-866-804-5926
Mississippi: 1-800-316-2273
Missouri: 1-866-687-8994
New Jersey: 1-866-687-8570
New York: 1-800-278-5155
Tennessee: 1-800-316-2273
Texas: 1-866-687-8878

RFI Remediation Line: 1-877-677-5609

Producers can now resolve Enrollment Requests for Information (RFI) by calling a centralized line and providing the necessary information to the representative for immediate correction and submission.

The benefits of this line are:

  • Centralized intake for RFI remediation.
  • Reduction in duplicate enrollment submissions.
  • Reduction in RFI remediation timeline.
  • Reduced administration to resolve RFI (i.e., duplication of efforts).

This process may require the producer to reach out to the beneficiary to obtain updated information prior to calling the RFI line. Below are the codes and a short description of the information needed to resolve an issue.

RFI Code Descriptions
HICN Not Found Transposed, Missing HICN
Demographic Correction
Name, DOB, Gender, etc.
Plan Code Correction
Incorrect Plan Selected for Eligibility
Perm Address
Address Corrections
ESRD Information
Missing answer to the ESRD Question
Part A and Part B Missing
Missing Effective Dates
Updated or Add SNP Verification # 
Caid Validation Number not noted


  • RFI Remediation Line

    RFI Remediation Line: 1-877-677-5609

    Producers can now resolve Enrollment Requests for Information (RFI) by calling a centralized line and providing the necessary information to the representative for immediate correction and submission.

    The benefits of this line are:

    • Centralized intake for RFI remediation.
    • Reduction in duplicate enrollment submissions.
    • Reduction in RFI remediation timeline.
    • Reduced administration to resolve RFI (i.e., duplication of efforts).

    This process may require the producer to reach out to the beneficiary to obtain updated information prior to calling the RFI line. Below are the codes and a short description of the information needed to resolve an issue.

  • RFI Code

    RFI Code Descriptions
    HICN Not Found Transposed, Missing HICN
    Demographic Correction
    Name, DOB, Gender, etc.
    Plan Code Correction
    Incorrect Plan Selected for Eligibility
    Perm Address
    Address Corrections
    ESRD Information
    Missing answer to the ESRD Question
    Part A and Part B Missing
    Missing Effective Dates
    Updated or Add SNP Verification # 
    Caid Validation Number not noted


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Last Updated On: 11/10/2015
Update on Heritage Health Member ID Cards WellCare has sent ID cards to members in the Heritage Health Nebraska plan. These ID cards should arrive soon, but if you have not received your ID card and need immediate care, please contact customer service at 1-855-599-3811 for assistance. ×