Claims

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.

Filing Claims with WellCare

• Electronic and Paper Claims Submissions

Institutional Claims/Encounter Guides

• 837 Institutional Encounter 5010v Guide
• 837 Institutional FFS Claims 5010v Guide

Professional Claims/Encounter Guides

• 837 Professional Encounter 5010v Guide
• 837 Professional FFS Claims 5010v Guide

Dental Claims/Encounters Guides

• Dental Claims Encounter Guide

Other Resource Guides

• HIPAA crosswalk with Claim Adjustment Reason Codes & Remittance Advice Remark Codes (PDF)
• Clinical Laboratory Improvement Amendments (CLIA) (PDF)
• Outbound Benefit Enrollment Companion (PDF)
• PHP Billing Guidance for Local W Code (PDF)
• Process for Corrected Claims and Voided Claims (PDF)