Summary of Change:
WellCare of Georgia has added a Claim Edit Guideline for institutional inpatient claims associated with a delivery event that occurred for a member enrolled in Georgia Families at the time of the delivery.
What does this mean for providers?
Beginning July 1, 2019, WellCare will deny any institutional inpatient delivery claim that does not have the following eligible procedure codes or diagnosis codes listed on the claim.
Eligible procedure codes:
59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622
Eligible diagnosis codes:
Z370, Z371, Z372, Z373, Z374, Z3751, Z3752, Z3753, Z3754, Z3761, Z3762, Z3763, Z3764, Z377
If you have any questions, please contact your local Hospital Services Specialist.
