HealthComp’s standard claim turnaround time is 30 business days. Wellfleet and HealthComp have been working on ways to enhance claims processing turnaround time. For any provider who has claims that are not getting paid in the standard 30 day turnaround time, please reach out to the Wellfleet/HealthComp main member customer service number at (833) 302-9785.
If a provider does not or can not resolve the issue using the main HealthComp Customer Service line, please contact Diana Cavazos, Wellfleet SHIP Administration, Health Comp Account Manager at; [email protected].
Refer to the PowerPoint Presentation, Slide #24 for the contact information for day-to-day questions and Slide #33, for the contact information for escalated issues.
During the 8/3/22 Town Hall Webinar, Wellfleet’s Provider Network Manager shared the logic regarding UCB SHIP Custom BH Provider fees:
When the UCB SHIP Custom BH network was being developed, Wellfleet and BlueShield worked together and reviewed the fees provided by Anthem (the previous network on the UCB SHIP plan prior to Wellfleet and BlueShield), and also reviewed Behavioral Health industry wide codes and fees in the Berkeley area. Based on that data, a custom BH base fee schedule was created. When providers were first contacted to join the custom BH network, some providers would not accept the base fees and Wellfleet and Blue Shield agreed to provide a rate increase to the base rates of approximately 20% – 30% above the base fee. We offered this significant increase in place of a 3% cost of living increase for each of the next 3 years. This was done to eliminate the need to create amendments each plan year as creating amendments is time consuming for both the provider and the network representatives. To ensure the UCB SHIP plan remains affordable to the students, BlueShield and Wellfleet have rate thresholds in place by provider license level.
Blue Shield reviews and documents each increase request received and if a provider’s fees are not above the set threshold, they have been contracted for one full year, and they have not received a fee increase in the previous year, the rate increase will be reviewed for a potential increase.
Wellfleet and Blue Shield are evaluating the fees on the UCB SHIP Custom BH base fee schedule for a potential increase in 2023 to the base fees. Once that analysis is complete, for providers who are on the base fee schedule and who are eligible to receive an increase from the base fees, they will be contacted by Blue Shield. This does not mean that every provider will automatically receive a fee increase since several providers have previously negotiated significant fee increases above the base fees.
Wellfleet and BlueShield explained the logic regarding the creation of base fees and fee increase requests along with the maximum fee thresholds. To ensure the UCB SHIP plan remains affordable to the students, BlueShield and Wellfleet have rate thresholds in place by provider license level.
If a provider would like to request an increase and discuss if they are eligible for an increase, they should contact the Blue ShieldCA network at the email ([email protected]) or phone number (800) 258-3091 option 3) on Slide 24 to discuss their specific contract and fee schedule.
In addition to the response to the above questions, the UCB SHIP Custom BH fee schedule includes a separate fee schedule for specific provider types. There are 3 separate fee schedules based on provider specialty: 1 for MD, 1 for PhD/PsyD, and 1 for LCSW, MFT, LPCC. When a provider contacts Blue Shield to join the Custom BH network, the fee schedule specific to the individual provider license level is presented. After a provider is contracted with Blue Shield for one full year, they may request a fee increase and if an increase is warranted, a fee increase may be provided. The fee schedule is reviewed in it’s entirety every few years to ensure the fees remain competitive and are within industry standards.
Magellan is not used on the UCB SHIP Plan with Wellfleet. In 2019, when Wellfleet became the insurance carrier for the UCB SHIP Plan, Magellan was removed from the plan.
For the first year to year-and-a-half of the UCB SHIP with Wellfleet and Blue Shield plan, the fees for providers who were contracted in 2019, were considered “evergreen”. Wellfleet and Blue Shield had to focus during that time to get as many of the 250+ community providers credentialed and contracted therefore, increases were not offered during that time. BlueShield is currently providing increases if a provider requests an increase and their current fees are under the maximum fee threshold.
Wellfleet and BlueShield are currently reviewing the base fee schedule and evaluating an increase to the UCB SHIP custom BH base fee schedule in 2023. Providers will be notified at that time if their fees qualify for an increase.
Wellfleet and BlueShield are currently reviewing the base fee schedule and evaluating proposed increases to the UCB Custom BH base fee schedule for 2023. Providers will be notified at that time if their fees qualify for an increase. This does not mean that all providers will receive a fee increase in 2023.
Blue Shield does not automatically increase all provider fees at the same time.
Cultural diversity is becoming increasingly critical to ensure that members can receive services from clinicians who speak their same language. Additional languages spoken are displayed in the Blue Shield online provider directory. However, at this time, Blue Shield does not provide additional compensation to clinicians for speaking additional languages.
The two primary contacts for providers to contact when they have inquires or issues with the UCB SHIP Insurance Plan are: BlueShield of California and HealthComp.
Please refer to Slide # 24 that includes the contact information for providers to contact when they have a question on the following items.
Contact HealthComp at (833) 302-9785 for assistance with the following items:
-member eligibility questions
-member benefit questions
-prior authorization requests
-claims processing inquires
-changes to demographic information (including Tax ID or address)
Contact Blue ShieldCA at (800) 258-3091 option 3, or at one of the emails on Slide 24 for assistance with the following items:
-Providers who KNOW they want to contract with BlueShieldCA for the custom BSC BH network
-Specific inquires on credentialing or contracting status after submission
-Changes to demographic information (including Tax ID or address)
-Initial questions on rates being offered
-Escalated issues related specifically to contracting or credentialing
-Rate increase requests
Providers may also use the Blue Shield Provider Connection Live Chat Feature – refer to Slide 24 for information about the live chat feature.
The majority of Blue Shield Custom BH providers have their Zelis epayment transaction fees waived. Wellfleet and Zelis have identified a few providers who are currently being charged the transaction fee. Those providers will be contacted by Zelis and Wellfleet to remove the fee from their transactions.
NOTE: The Zelis epayment transaction fee waiver applies to providers contracted with the UCB SHIP Custom BH network only. This does not apply to contracts providers may have with any other networks or carriers using Zelis for provider payments.
Please see the response to Q11 above.
Wellfleet reached out to Zelis regarding this issue and Zelis will no longer set up UCB SHIP Custom BH providers with virtual credit cards or electronic payment unless the provider contacts Zelis directly to request epayments.
Yes, Providers can visit the Zelis website at www.zelispayments.com or contact Zelis by phone at (877) 828-8770. Zelis will walk providers through the process to set up electronic payments to view payments.
Wellfleet reached out to Zelis to discuss the lengthy phone wait time and the 3-5 day wait time for an email response and Wellfleet is continuing to discuss and monitor these items with Zelis.
The UCB SHIP Plan renewed with Blue Shield and Wellfleet for the 2022/2023 school plan year. There are many factors involved with a school’s selection of an insurance company and network. That decision is up to the school and is based on the needs of the school.
That is correct, the UCB SHIP Custom BH Provider network was specifically designed for the Berkeley Community providers who only wish to see UCB SHIP students and who do not want to participate with the larger Blue Shield network.
From the UCB CAPS Center perspective, the response to this questions is, “it depends”. For students who need services for anxiety for example, they can get in with a counselor relatively quickly. However, for members with specific needs such as OCD, ADHD, eating disorders, post hospital, etc., pairing members with these types of providers is more difficult as there are not that many providers in general who have these specialties.
If students are solely relying on and using “Psychology Today” for example; they may be calling providers who are not taking students.
For students who are using the Wellfleet/HealthComp UCB SHIP provider finder tool, they may be selecting providers who are not accepting new patients.
For students who are having success getting in with providers, they are most likely navigating the tools correctly. We would recommend students contact the CAPS center or Wellfleet/HealthComp for assistance with locating providers who are accepting new patients.
The Blue Shield network is broad and includes many providers. UCB SHIP members have access to the UCB SHIP Custom BH network and also to providers contracted with the larger Blue Shield PPO Network. From the Network and Insurance Company perspective, state entities monitor the number of providers to members in a given state and service area to assess provider to member availability and accessibility issues.
Whether you’re a current Wellfleet Student member, administrator, or partner, contact us with any questions you have. We’ll look forward to hearing from you.
©2022 Wellfleet Group, LLC. All Rights Reserved.
Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.