Claims

WellCare of Kentucky wants to ensure that claims are handled as efficiently as possible. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements.

Reimbursement Policies

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.

Guides

Institutional Claims/Encounter Guides

• 837 Institutional Encounter 5010v Guide (PDF)
• 837 Institutional FFS Claims 5010v Guide (PDF)

Professional Claims/Encounter Guides

• 837 Professional Encounter 5010v Guide (PDF)
• 837 Professional FFS Claims 5010v Guide (PDF)

Claims Samples and Guidelines

• Billing, Rendering and OPR Roster Edits (PDF)
• CMS 1500 Submission Sample (PDF)
• NDC Reporting Guidelines (PDF)
• Outbound Benefit Enrollment Companion (PDF)
• Process for Corrected Claims and Voided Claims (PDF)
• Taxonomy Guide (PDF)
• UB04 Submission Sample (PDF)