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Special Supplemental Benefits for the Chronically Ill (SSBCI)

Date: 01/29/26

Special Supplemental Benefits for the Chronically Ill (SSBCI) can be offered to Medicare Advantage (MA) members who have one or more complex chronic conditions, are at high risk for hospitalization or adverse health outcomes and require intensive care coordination. The program is designed to support individuals by offering additional services beyond standard Medicare coverage.

  • Eligibility Criteria for SSBCI: Members must require intensive care management, be at high risk for unplanned hospitalization, and have a documented qualifying chronic conditions that significantly limits overall health or function.
  • Eligibility Determination Process: Eligibility is identified automatically weekly using internal and claims data or manually through provider attestation when claims data is unavailable, requiring an in-person visit or provider confirmation.
  • Provider Attestation and Member Notification: Providers complete attestations online through Wellcare's Attestation for SSBCI webpage (ssbci.rrd.com) confirming eligibility and submit claims with appropriate diagnosis codes. Members will receive approval or denial letters within 10 business days detailing benefits and access instructions if approved.

For more detailed information on this process, please visit the Special Supplemental Benefits for the Chronically Ill (SSBCI) section of the Wellcare webpage.