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Provider : Claimsupdates

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.
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
2011 Step Actions for Dual Claims Payment Companion Guide

NPI Requirements
Compliance with the National Provider Identifier (NPI) mandate is critical. Since May 23, 2008, claims submitted to WellCare, and/or designees of WellCare, must comply with the requirements to use only the NPI on standard transactions.
Click here to view WellCare's NPI Policy and for instructions for submitting your NPI to WellCare.

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