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New Modifier Claims Edit Guideline CEG

Summary of change: 

WellCare has added a Claims Edit Guideline (CEG) for procedure-to-procedure associated modifiers. 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 Modifier CEG to ensure the extent and nature of the services rendered for a patient’s condition, as well as verify the claim is coded correctly for the services billed. Therefore, providers may experience an increase in requests for medical record submissions when billing modifiers, including 24, 25, 59, XE, XP, XS or XU.

Why is WellCare implementing this policy?

The intent of this change is to ensure appropriate use of modifiers upon claim submissions. Once the requested medical records are received and reviewed, WellCare will approve final payment if claims have appropriately used the referenced modifiers.

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Last Updated On: 8/7/2018