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Claims Updates
- Reimbursement Policies
From time to time, WellCare Health Plans, Inc. (the Plan), reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS) and nationally recognized health and medical societies.
For WellCare Medicare coordinated care lines of business and for the New York Medicaid line of business, click the link below to access our current reimbursement policies.
Current WellCare Reimbursement Policies
- HIPAA Adjustment Reason Code Changes
- New York Claims Software and Significant Claims Edits
WellCare uses McKesson claims editing software, ClaimsXten 2.0, and iHealth Technologies for review of claims. Additionally, WellCare applies the significant claims edits described in the spreadsheet at the link below.
Click here to view the spreadsheet.
- Present on Admission (POA) Frequently Asked Questions
- Explanation of Payment Enhancements
- Claims/Encounter Companion Guides
Institutional Claims / Encounter Guide
Professional Claims / Encounter Guide
Dental Claims / Encounter Guide
Outbound Benefit Enrollment Companion Guide
The links above require the ability to open .pdf files. If for any reason you are not able to view these links, please click here to download Adobe Reader.
WellCare Web Sites
About WellCare
