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Inappropriate Primary Diagnosis Codes


Dear Provider,

Thank you for your continued partnership with Wellcare. Thank you for your continued partnership with Wellcare. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of new policies Wellcare will be implementing effective on or after 8/1/2023.

Edit Name Description Lines of Business
Inappropriate Primary Diagnosis Deny or limit diagnosis codes based upon correct coding guidelines that are supported by CMS and ICD-10. Based on these guidelines, claims will deny when billed with unacceptable primary/principal diagnosis, manifestation diagnosis, and sequela diagnosis in outpatient or inpatient facilities.  Medicare

Thank you for your continued partnership, participation, and cooperation in our ongoing efforts to render the highest quality healthcare to our members, together. 


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Last Updated On: 5/24/2023