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Readmission Policy Update

Summary of change: 

WellCare Health Plans, Inc., has updated its policy for inpatient readmissions. Please share this notice with other members of your practice and office staff.

What does this mean for providers?

Beginning May 15, 2018, our clinical teams will use the Inpatient Readmission Policy to ensure readmission services occur when a patient is discharged/transferred from an acute care Prospective Payment System (PPS) hospital, and is readmitted to the same acute care PPS hospital, or hospital within the same network, within 30 days for symptoms related to, or for evaluation and management of, the prior stay’s medical condition. If the readmission to the same hospital occurs on the same day of discharge, that hospital shall adjust the original claim generated for the original stay by combining the original and subsequent stay into a single claim.

The readmission policy has been updated to include prepay procedures to align with our existing post-pay policy.  This is not a new policy. The WellCare Medicare Advantage and Medicaid Provider Manuals address inpatient readmission guidelines. WellCare is executing readmission criteria published by federal and state agencies. 

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Last Updated On: 12/29/2020