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WellCare of North Carolina Provider Notification August 2024

Dear Provider,

We hope this message finds you well. Thank you for your continued partnership with Health Plan Name. 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 an additional review that will go into place.

Lines of Business: Medicare, Marketplace Commercial
Description of Changes: Enforcement of National Coverage Determination (NCD) guidelines when diagnostic lab testing services are billed only with a diagnosis that is not covered per the NCD.

Lines of Business: Medicare
Description of Changes: Enforcement of several National Coverage Determinations (NCDs) to be in accordance with CMS guidelines for correct coding.

Lines of Business: Medicare, Medicare, Marketplace Commercial
Description of Changes: Enforcement of Correct Coding Guidelines regarding the use of the same revenue code for duplicate services.

Lines of Business: Medicare
Description of Changes: Enforcement of Correct Coding Guidelines regarding DME Orthosis and incorrect usage of modifiers.

Thank you for your ongoing collaboration and commitment to providing quality health care to our members.

Should you have any questions or require further assistance, please do not hesitate to reach out to your designated Provider Representative or contact our Provider Services team at ncproviderrelations@wellcare.com.

Warm regards,

The Provider Services Team
WellCare of North Carolina