Payment Policy
This notice is to clarify a segment of WellCare's payment policy language applicable to all WellCare Medicaid markets. WellCare's payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), state health care agencies and medical specialty professional societies.
If you have questions about this information, please contact your Provider Relations representative.
- 3-Day Payment Window: CC.PP.500 (PDF)
- 340B Drug Payment Reduction: CPP-150 (PDF)
- Allergy Testing and Immunotherapy: CPP-112 (PDF)
- Appropriate Place of Service (POS) Billing: CPP-144 (PDF)
- Code Editing Overview: CC.PP.011 (PDF)
- Comprehensive Payment Integrity (CPI): CPP-160 (PDF)
- E/M Over-coding Policy: CPP-143 (PDF)
- E/M Visits Bundled with Dipsticks Venipuncture Catheter Services: CPP-158 (PDF)
- Emergency Department Facility Coding: CPP-105 (PDF)
- Extended Ophthalmoscopy: CP.VP.26 (PDF)
- External Ocular Photography: CP.VP.43 (PDF)
- Fluorescein Angiography: CP.VP.28 (PDF)
- Frequency of Comprehensive Ophthalmological Exams: CPP-151 (PDF)
- Fundus Photography: CP.VP.29 (PDF)
- Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing: CP.MP.209 (PDF)
- Gonioscopy: CP.VP.31 (PDF)
- Inpatient Notification: CPP-101 (PDF)
- Inpatient Readmissions: CPP-124 (PDF)
- Intensity Modulated Radiation Therapy (IMRT): CPP-108 (PDF)
- Maximum Units for Reimbursement: CPP-111 (PDF)
- NICU Level of Care Authorization and Reimbursement Matching: CPP-163 (PDF)
- Optum CPI DRG Analytics: CPP-166 (PDF)
- Pediatric Intensive Care Unit Care Authorization and Reimbursement Matching: KY.PP.400 (PDF)
- Polymerase Chain Reaction Respiratory Viral Panel Testing: CPP-161 (PDF)
- Post Payment Review Policy: CPP-148 (PDF)
- Pre-Payment Clinical Validations: CPP-152 (PDF)
- Procedure to Procedure Associated Modifiers: CPP-127 (PDF)
- Renal Dialysis: CPP-114 (PDF)
- Robotic Assisted Surgery: CPP-137 (PDF)
- Scanning Computerized Ophthalmic Diagnostic Imaging: CP.VP.14 (PDF)
- Severe Malnutrition Policy: CPP-145 (PDF)
- Sepsis Diagnosis: CC.PP.073 (PDF)
- Ultrasound in Pregnancy: CP.MP.38 (PDF)
- Visual Field Testing: CP.VP.63 (PDF)