Texas Providers

Condition Care


The Condition Care Program (CNDC) is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

Our mission

The mission of the CNDC program is to improve the health and quality of life for our members served by encouraging member self-care efforts, coordinating healthcare education and providing interventions along the continuum of care.

CNDC services include:

  • A holistic, member-centric approach to condition care, 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 healthcare needs of our member population
  • Weight management and smoking cessation education

Who is eligible?

Members diagnosed with one or more of the conditions listed are eligible for CNDC services:

  • Asthma
  • Bipolar disorder
  • Chronic obstructive pulmonary disorder (COPD)
  • Congestive heart failure (CHF)
  • Coronary artery disease (CAD)
  • Diabetes
  • HIV/AIDS
  • Hypertension
  • Major depressive disorder — adult
  • Major depressive disorder – child/adolescent
  • Schizophrenia
  • Substance use disorder

How can I refer a member to this program?

To refer a member to the Condition Care Program, fill out our CNDC Referral Form and email the completed form to Condition-Care-Provider-Referrals@wellpoint.com.

Email:

Condition-Care-Provider-Referrals@wellpoint.com

CNDCs are designed to:

  • Address gaps in care
  • Improve the understanding of disease processes
  • Improve the quality of life for members
  • Support collaboration to develop member-centered goals and interventions
  • Support network provider relationships with members
  • Increase network provider awareness of CNDC programs
  • Reduce acute episodes requiring emergent or inpatient care
  • Identify social determinants of health and address by referring members to appropriate community resources

Program features include:

  • Proactive population identification processes
  • Programs are based on 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 to healthy behaviors and compliance or monitoring, and care management for high-risk members
  • Ongoing communication with primary and ancillary providers regarding patient status
Accredited NCQA Health Plan

Nine of our programs are National Committee for Quality Assurance (NCQA) accredited and incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.

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 to assist you in creating an individual plan of care for your patient.

Receive feedback on your patients

Providers can access Patient360 through Availity to obtain feedback on their patients regarding their care plans and condition management while patients are enrolled in our program.

How to contact us

Email us at Condition-Care-Provider-Referrals@wellpoint.com or call 1-888-830-4300 from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail is available 24 hours a day.

Email:

Condition-Care-Provider-Referrals@wellpoint.com

Call:

1-888-830-4300

Hours of operation

From 8:30 a.m. to 5:30 p.m. local time, Monday through Friday to reach a CNDC staff member. Confidential voicemail is available 24 hours a day.

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 your patients
  • Be informed how the organization coordinates interventions with care plans for individual members
  • Know how to contact the care manager responsible for managing and communicating with your patients
  • Be supported by the organization when interacting with members to make decisions about their healthcare
  • Receive courteous and respectful treatment from the organization’s staff
  • Communicate complaints to the organization

A copy of these rights and responsibilities can also be found in the provider manual.

The Clinical Practice Guidelines (CPGs) for the chronic conditions outlined above are available on Availity , our secure provider website. CPGs can also be requested at any time.

Our CNDC programs do not advertise, market or promote specific products or services to members or providers. They do not have any financial ownership arrangements with anyone who advertises, markets or provides the goods and services we offer.

Provider tools & resources

Interested in becoming a provider in the Wellpoint network?

We look forward to working with you to provide quality services to our members.