Managing Duals Digitally – Frequently Asked Questions

Date: 01/02/26

Background: In 2026, Wellcare By Meridian will offer an integrated dual special needs plan (D-SNP) for members eligible for both Medicare and Medicaid. Managing care for these Duals members in our digital tools will remain familiar with similar workflows you rely on today for other lines of business, plus some enhancements for more integrated views across Medicaid and Medicare benefits.

1. What functionality is available to support the new integrated dual plans?
In both Availity Essentials and in the portal, providers can:

• Verify Eligibility
  • Check eligibility with the integrated Member ID (single ID for both Medicaid and Medicare)
  • Receive Provider Alerts for a Member in deeming status so you can clearly see their eligibility start date
• View Member Benefits
  • View Medicare and Medicaid Benefits in a single screen within the tool
• Submit or search for a single authorization
• Submit Claims & Claims Appeals
  • Submit and search for a single Claim (by using the integrated Member ID)
  • Look up a claim and submit a reconsideration or appeal of the payment decisiono Look up the details of a member’s care plan

2. What other features are accessible in Availity Essentials?
Within Availity Essentials, you can also view an image of the Member’s ID Card in the Member Eligibility screen. This capability is not available in the portal.

3. What other features are accessible in the portal?
In the portal, providers can find Care Team contact information by using the Eligibility search, selecting View Patient Info, and then choosing Care Team Contacts in the left-hand navigation. This functionality is available in mid-January.

This capability is not available in Availity Essentials, but providers can navigate to the portal from the Secure Provider Portal Login link in the Resources section of the Payer Space.

4. Will there be any changes to how providers view or receive payments?
Yes. Providers will receive a single payment, 835, and EOP that displays both the Medicare and Medicaid claims. Both our portal and Availity Essentials support viewing payment details on a single screen.

For payments through Payspan/Zelis: If a provider is registered with Payspan/Zelis, they also must add the Duals line of business to their TIN to begin receiving payments. If a provider does not add the Duals line of business, payments will be sent via check.

New to Payspan/Zelis? Register at payspanhealth.com or call 1-877-331-7154.

5. How can I get access to the portal or Availity Essentials?

Portal: You can log in or sign up to access our portal at the following link: https://wellcare.mimeridian.com/for-providers.html

Availity: If you are already working in Availity Essentials, you can log in to your existing account through the Availity Essentials portal. If you are new to Availity Essentials, getting your Availity Essentials account is the first step. Visit the Register and Get Started with Availity Essentials webpage for training and to access other helpful resources.

6. What training opportunities are available?
Providers already registered with Availity can visit the News and Announcements section within Payer Spaces to register for training.