Wellcare Reimbursement Guidelines Archives

MULTIPLE SURGERY BILLING GUIDELINES

THE APPROPRIATE APPLICATION OF MODIFIER 51 FOR WELLCARE CLAIMS Unlike the other insurances Wellcare will not systematically apply the Modifier 51 to a claim line when the multiple surgery reduction rules apply. Wellcare will deny the claim and require the provider to re-submit the claim with the Modifier 51. Hence modifier 51 should be used…

WELLCARE CLAIM PAYMENT POLICIES

Evaluation and Management (E&M) Services New Patient Visits: The AMA defines a new patient as “one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years.” Given this definition, if a physician bills a new patient…