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Provider Demographic Information - WellCared Services LLC

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	WellCared Services LLC
Address:	351 BROOKLINE BLVD PITTSBURGH, PA 15226-1709
Phone:	(850) 583-1846
E-mail:	derrick.pollock@wellcaredservices.com
Web Site:	N/A

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	WELLCARED SERVICES
Address:	351 BROOKLINE BLVD PITTSBURGH, PA 15226-1709
Phone:	(850) 583-1846

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Allegheny
\|Service Name / Level	\|Rate

Companion Services (Basic Staff Support)	$3.45 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
Remote Support - Technology/Equipment	Not Set
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-2 Person-NG5-Elig	$1,312.57 / 1 Day
Res Hab-2 Person-NG5-Elig-w/Day Supports	$1,215.16 / 1 Day
Res Hab-3 Person-NG 1-Elig	$411.03 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$312.16 / 1 Day
Res Hab-3 Person-NG 2-Elig	$468.38 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$361.68 / 1 Day
Res Hab-3 Person-NG 3-Elig	$545.05 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$467.35 / 1 Day
Res Hab-3 Person-NG 4-Elig	$662.22 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$513.07 / 1 Day
Res Hab-3 Person-NG5-Elig	$1,004.32 / 1 Day
Res Hab-3 Person-NG5-Elig-w/Day Supports	$835.46 / 1 Day
Res Hab-Lic-1 Person-Inelig	$93.64 / 1 Day
Res Hab-Lic-2 Person-Inelig	$50.22 / 1 Day
Res Hab-Lic-3 Person-Inelig	$35.47 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Eligible)	$140.44 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Eligible) - TD	$140.44 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Eligible) - TE	$140.44 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Inelig)	$25.16 / 1 Day
Resid Hab-Unlic 2-Indiv Home (Eligible)	$88.19 / 1 Day
Resid Hab-Unlic 2-Indiv Home (Eligible) - TD	$88.19 / 1 Day
Resid Hab-Unlic 2-Indiv Home (Eligible) - TE	$88.19 / 1 Day
Resid Hab-Unlic 2-Indiv Home (Inelig)	$13.95 / 1 Day
Resid Hab-Unlic 3-Indiv Home (Eligible)	$63.71 / 1 Day
Resid Hab-Unlic 3-Indiv Home (Eligible) - TD	$63.71 / 1 Day
Resid Hab-Unlic 3-Indiv Home (Eligible) - TE	$63.71 / 1 Day
Resid Hab-Unlic 3-Indiv Home (Inelig)	$7.50 / 1 Day
Respite, Non-Waiver Setting/PLF, NG 1	Not Set
Respite, Non-Waiver Setting/PLF, NG 2	Not Set
Respite, Non-Waiver Setting/PLF, NG 3	Not Set
Respite, Non-Waiver Setting/PLF, NG 4	Not Set
Respite, Non-Waiver Setting/PLF, NG5	Not Set
Respite-Unlic- 15-min (Basic 1:4)	$2.44 / 15 min.
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd)	$13.28 / 15 min.
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd) - TD	$13.28 / 15 min.
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd) - TE	$13.28 / 15 min.
Respite-Unlic-15-min(Level 1, 1:3) Out-of-Home	$3.22 / 15 min.
Respite-Unlic-15-min(Level 2, 1:2)Out-of-Home	$4.75 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)Out-of-Home	$8.59 / 15 min.
Respite-Unlic-15-min(Level 4, 2:1 Enh) - TD	$21.74 / 15 min.
Respite-Unlic-15-min(Level 4, 2:1 Enh) - TE	$21.74 / 15 min.
Respite-Unlic-15-min(Level 4, 2:1 Enhanced)	$21.74 / 15 min.
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	$17.03 / 15 min.
Respite-Unlic-Day (Basic 1:4) Out-of-Home	$97.84 / 1 Day
Respite-Unlic-Day (Level 1, 1:3) Out-of-Home	$128.64 / 1 Day
Respite-Unlic-Day (Level 2, 1:2) Out-of-Home	$190.26 / 1 Day
Respite-Unlic-Day (Level 3, 1:1 Enh) Out-of-Home	$531.24 / 1 Day
Respite-Unlic-Day (Level 3, 1:1 Enh)Out-of-Hme -TD	$531.24 / 1 Day
Respite-Unlic-Day (Level 3, 1:1 Enh)Out-of-Hme -TE	$531.24 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	$343.22 / 1 Day
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	$681.46 / 1 Day
Respite-Unlic-Day(Level 4, 2:1 Enh) Out-of-Home-TD	$869.48 / 1 Day
Respite-Unlic-Day(Level 4, 2:1 Enh) Out-of-Home-TE	$869.48 / 1 Day
Respite-Unlic-Day(Level 4, 2:1 Enhcd) Out-of-Home	$869.48 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

County : Lawrence
\|Service Name / Level	\|Rate

Remote Support - Technology/Equipment	Not Set
Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-2 Person-NG5-Elig	$1,312.57 / 1 Day
Res Hab-2 Person-NG5-Elig-w/Day Supports	$1,215.16 / 1 Day
Res Hab-3 Person-NG 1-Elig	$411.03 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$312.16 / 1 Day
Res Hab-3 Person-NG 2-Elig	$468.38 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$361.68 / 1 Day
Res Hab-3 Person-NG 3-Elig	$545.05 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$467.35 / 1 Day
Res Hab-3 Person-NG 4-Elig	$662.22 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$513.07 / 1 Day
Res Hab-3 Person-NG5-Elig	$1,004.32 / 1 Day
Res Hab-3 Person-NG5-Elig-w/Day Supports	$835.46 / 1 Day
Res Hab-Lic-1 Person-Inelig	$93.64 / 1 Day
Res Hab-Lic-2 Person-Inelig	$50.22 / 1 Day
Res Hab-Lic-3 Person-Inelig	$35.47 / 1 Day
Respite, Non-Waiver Setting/PLF, NG 1	Not Set
Respite, Non-Waiver Setting/PLF, NG 2	Not Set
Respite, Non-Waiver Setting/PLF, NG 3	Not Set
Respite, Non-Waiver Setting/PLF, NG 4	Not Set
Respite, Non-Waiver Setting/PLF, NG5	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

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