Condition Care
Our Condition Care Program (CNDC) is based on a system of coordinated care management interventions and communications designed to support physicians and other health care professionals in managing members with chronic conditions.
Our mission
The CNDC mission is to improve the health and quality of life for the members we serve. We do this by encouraging self-care efforts, coordinating health care education and providing interventions along the continuum of care.
CNDC services include:
- A holistic, member-centric approach to disease management focusing on the needs of the member through telephonic and community-based resources
- Motivational interviewing techniques used in conjunction with member self-empowerment
- The ability to manage more than one disease to meet the changing health care needs of our member population
- Weight management and smoking cessation education
Who is eligible?
Members diagnosed with one or more of the conditions listed below are eligible for CNDC services:
- Asthma
- Bipolar disorder
- Coronary artery disease
- Congestive heart failure
- Chronic obstructive pulmonary disease
- Diabetes
- HIV/AIDS
- Hypertension
- Major depressive disorder — adults
- Major depressive disorder — children/adolescents
- Schizophrenia
- Substance use disorder
How can I refer a member to this program?
Fill out our Condition Care Referral Form and email the completed form to Condition-Care-Provider-Referrals@wellpoint.com.
Email:
Program features
- Proactive population identification processes
- Evidence-based national practice guidelines
- Collaborative practice models to include physician and support service providers in treatment planning for members
- Continuous patient self-management education, including primary prevention, coaching related by healthy behaviors modification programs and compliance or monitoring, and case management for high-risk members
- Ongoing communication with primary and ancillary providers regarding patient status
- NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care
CNDC programs are designed to:
- Address gaps in care
- Improve member understanding of disease processes
- Improve the quality of life for members
- Collaborate with providers to develop member-centered goals and interventions
- Support relationships between the member and provider networks
- Increase network provider awareness of CNDC
- Reduce acute episodes requiring emergent or inpatient care
- Identify social determinants of health and address them by referring members to appropriate community resources
What are the benefits of collaborating with CNDC?
Quality of care
If you have patients with one or more of the conditions listed above who could benefit from additional education or care management, we encourage you to refer them to CNDC.
Collaborative treatment plans
CNDC invites your input for patient treatment plans. We provide you with CNDC information and the most up-to-date Clinical Practice Guidelines (CPGs) to assist in creating an individual plan of care for your patient. CPGs are available in Availity (login is required).
Receive feedback on your patients between appointments
You can access Patient360 to obtain feedback on your patients regarding their care plans and condition management while enrolled in our program.
How to contact us
Call:
Monday-Friday, 8:30 am – 5:30 pm local time
Confidential voicemail is available.
Email:
Clinical Health Promotion Program
Healthy Families Program
Program offering families assistance with leading a healthy lifestyle and improving childhood obesity in our members. The Healthy Families program helps members by providing education, community resources, and individualized plans of care over a 6-month period. Program offered to members ages 7 to 17.
How can I refer a member to the Healthy Families Program?
To refer a member to the Wellness Program or Healthy Families Program, fill out our CHP Program Referral Form and email the completed form to:
Email:
Provider rights and responsibilities
You have additional rights and responsibilities, such as the right to:
- Obtain information about the organization’s services, staff qualifications and any contractual relations
- Decline to participate in or work with the organization’s programs and services on behalf of their patients
- Be informed how the organization coordinates interventions with care plans for individual members
- Know how to contact the case manager responsible for managing and communicating with their patients
- Be supported by the organization when interacting with members to make decisions about their health care
- Receive courteous and respectful treatment from the organization’s staff
- Communicate complaints to the organization
The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are available on Availity , our secure provider website. CPGs can be requested at any time.
Our CNDCs do not advertise, market or promote specific products or services to members or providers. We do not have financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Policies, Guidelines & Manuals
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
- Electronic Data Interchange
Interested in becoming a provider in the Wellpoint network?
We look forward to working with you to provide quality service for our members.
Join Our Network