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Claims

WellCare of Kentucky wants to ensure that claims are handled as efficiently as possible. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements.

Reimbursement Policies

From time to time, WellCare Health Plans 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.


Institutional Claims/Encounter Guides

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions.

Professional Claims/Encounter Guides

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Claims Samples and Guidelines

Effective June 1, 2017, WellCare will be implementing new front end edits to align with the new requirements of the Kentucky Department for Medicaid Services.

Explains how to receive, load and send 834 EDI files for member information.

Instructions on how to submit a corrected or voided claim.

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Last Updated On: 2/4/2019