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Provider : Claimsupdates
Please refer to the links below to access important WellCare claims guides and updates.
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Reimbursement Policies
From time to time, WellCare Health Plans, Inc. (the Plan), 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.
Click the link below to access our current reimbursement policies.
Current WellCare Reimbursement Policies
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WellCare of Ohio Claims Software
WellCare of Ohio uses McKesson Corp. claims editing software, ClaimsXten 2.0, and iHealth Technologies for review of claims.
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Claims/Encounter Companion Guides
Institutional Claims / Encounter Guide
Professional Claims / Encounter Guide
Dental Claims / Encounter Guide
Outbound Benefit Enrollment Companion Guide
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HIPAA Adjustment Reason Code Changes
- Explanation of Payment Enhancements
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NPI Compliance
Compliance with the National Provider Identifier (NPI) mandate is critical. Since May 23, 2008, claims submitted to WellCare of Ohio must comply with the requirement to use only the NPI on standard transactions.
View WellCare's NPI Policy and for instructions for submitting your NPI to WellCare. (This will redirect to our corporate website.)
All links associated in the section above require the ability to open .pdf files. If for any reason you are not able to view these links, please download the reader software.
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About Wellcare
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