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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.

Institutional Claims/Encounter Guides

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions.

Professional Claims/Encounter Guides

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Claims Samples and Guidelines

Effective June 1, 2017, WellCare will be implementing new front end edits to align with the new requirements of the Kentucky Department for Medicaid Services.

Explains how to receive, load and send 834 EDI files for member information.

Instructions on how to submit a corrected or voided claim.

Helpful Information

Claims Submission Tips

  • Providers should include Payer ID 14163 on claims submissions.
  • As applicable, include Payer ID 59354 on claims encounter submissions.

 

EDI Notice

RelayHealth, a division of McKesson, manages all claims electronic data interchange (EDI) between Staywell and our providers. If you need assistance, please contact RelayHealth at 1-866-855-4723, or your vendor may call 1-888-743-8735.

Taxonomy

WellCare wants to continue to encourage providers to submit claims with the correct taxonomy code consistent with the provider's specialty and services being rendered in order to increase appropriate adjudication. WellCare may reject the claim or pay it at the lower reimbursement rate if the taxonomy code is incorrect or omitted.
  • Claims Submission Tips

    Claims Submission Tips

    • Providers should include Payer ID 14163 on claims submissions.
    • As applicable, include Payer ID 59354 on claims encounter submissions.

     

  • EDI Notice

    EDI Notice

    RelayHealth, a division of McKesson, manages all claims electronic data interchange (EDI) between Staywell and our providers. If you need assistance, please contact RelayHealth at 1-866-855-4723, or your vendor may call 1-888-743-8735.

  • Taxonomy

    Taxonomy

    WellCare wants to continue to encourage providers to submit claims with the correct taxonomy code consistent with the provider's specialty and services being rendered in order to increase appropriate adjudication. WellCare may reject the claim or pay it at the lower reimbursement rate if the taxonomy code is incorrect or omitted.

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Last Updated On: 5/8/2017