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WellCare Transition to Fidelis Care - Claim Submission, Correspondence and Contact Resources
5/18/2020 • Posted by Provider Relations

As a reminder, effective June 1, 2020, WellCare of New York, Inc. will migrate to Fidelis Care, a Centene company. This announcement is to help providers with changes affecting current New York Medicaid members’ 2020 Claim Submissions, Member Eligibility, Claim Status Inquires, and Customer Service information. 

We want to help your billing department process your claim submissions as efficiently as possible. Please use the date of service guidance below to send a claim submission to the correct payer to avoid a rejection for eligibility.

NOTICE: Claim submissions submitted to WellCare for dates of services after the member migrates to the Fidelis plan may receive the below rejection description.

WellCare Eligibility Rejection Description: Patient was not eligible for benefits under this WellCare plan (PayerID 14163) for this date of service. Please review the Subscriber's ID card; they may be covered under the Fidelis Plan (PayerID 11315) for dates of service on or after 06/01/2020.

CLAIMS SUBMISSIONS DATE OF SERVICE GUIDANCE

File Type Definitions:

  • Fee-For-Service (FFS) defined in the Transaction Type Code BHT06 as CH, which means Chargeable, expecting adjudication.
  • Encounters (ENC) defined in the Transaction Type Code BHT06 as RP, which means Reportable only, NOT expecting adjudication. 

Date of Service

Health Plan Name

Transaction Type (CH/RP)

Claim Type

Clearinghouse Payer ID

Paper Claim Submissions

Before     06/01/2020

 

WellCare of New York, Inc. (Medicaid)

Fee-For-Service

Professional  and    Institutional

14163

WellCare Health Plans
Claims Department
P.O. Box 3137
Tampa, FL 33631-3372

 

Before
06/01/2020

 

WellCare of New York, Inc. (Medicaid)

     Encounter

Professional  and    Institutional

59354

WellCare Health Plans
Claims Department
P.O. Box 31372
Tampa, FL 33631-3372

On or after
06/01/2020

Fidelis Care, a Centene Company

Fee-For-Service & Encounter

  Professional

11315

Medicaid, CHP, & Essential Plan:
Fidelis Care
P.O. Box 898
Amherst, NY 14226-0898

On or after
06/01/2020

 

Fidelis Care,
a Centene Company

Fee-For-Service Encounter

Institutional

11315

Medicaid, CHP, & Essential Plan:
Fidelis Care
P.O. Box 806
Amherst, NY 14226-0898

Please Note: For fastest, most accurate processing, EDI is the preferred method.

INSTRUCTIONS ON HOW TO DETERMINE CORRECT PAYER FOR DATE OF SERVICE

If billing a professional submission with services spanning before and after 06/01/2020, to avoid rejection, please split the services into two separate claim submissions for the guidance outlined below. 

  • ​Professional (837P) service date for all claim lines in Loop 2400 (DTP*472*from-through~)
  • FL-24a unshaded area on the CMS1500 02/12 paper form.

If billing a professional or an outpatient bill type institutional submission, please use the earliest From Date in the claim submission for the guidance outlined below.

  • Professional (837P) earliest service date in all claim lines is in Loop 2400 (DTP*472*from-through~)
  • ​FL-24a unshaded area on the CMS1500 02/12 paper form.
  • ​Institutional statement date is in Loop 2300 (DTP*434*from-through~)
  • ​FL-06 of the UB-04 CMS-1450 paper form.​

If billing an institutional inpatient bill type submission, please use the From Date Institutional Statement Date in the claim submission for the guidance outlined below.  

  • Institutional statement date is located in Loop 2300 (DTP*434*from-through~)
  • ​FL-06 of the UB-04 CMS-1450 paper form.

REAL-TIME CONNECTIVITY

Vendor Partner

Health Plan

Phone Numbers

Change Healthcare

WellCare of New York, Inc. & Fidelis Care

1-877-363-3666, prompt 1

TransUnion® Healthcare

WellCare of New York, Inc. & Fidelis Care

1-877-732-6853

Availity®

WellCare of New York, Inc.

1-800-282-4548

AdminisTEP.com

WellCare of New York, Inc.

1-888-751-3271


These services improve data interchanges, provide an innovative solution to provider requests and will be leveraged to implement other Health Insurance Portability and Accountability Act (HIPAA) – compliant transactions in the future:

  • Real-time eligibility and claim status information – no waiting on the phone
  • Low or no cost to the provider community
  • Increased office productivity
  • One-stop shopping view eligibility and claim status information for all participating health insurance companies from a single website with a single login

CORRESPONDENCE

Please be aware, your billing department must submit to the appropriate payer to prevent submission delays. Use the same date of service logic provided on the first page to determine the correct payer to mail any paper submissions. 

Correspondence Type

  Date of Service

Claim Payment

Claim Payment Disputes (Related to untimely filing, incidental procedure, unlisted procedure code)

  Before 06/01/2020

WellCare Health Plans
Claim Payment Disputes
P.O. Box 31370
Tampa, FL 33631-3370

Claim Appeals

(Medical necessity, authorization denials, benefits)

Before 06/01/2020

WellCare Health Plans
Attn: Appeals Department
P.O.Box 31368
Tampa, FL 33631-3368

All Correspondence
-Claim Administrative Reconsideration
-Adjustment
-Claim Appeals/Claim Invoices
-Customer Service Representatives (CSR)     Documentation (if using paper version)

On or after 06/01/2020

Fidelis Medicaid
P.O. Box 10500
Farmington, MO 63640-5001


ELECTRONIC FUNDS TRANSFER (EFT) AND ELECTRONIC REMITTANCE (ERA)

Please review the changes for EFT/ERA. PaySpan® Health will no longer be the provider for free Electronic Funds Transfer (EFT) and Electronic Remittance Advice/Explanation of Payment (ERA/EOP) once New York Medicaid members migrate to Fidelis Care.

Date of Service

Electronic Funds Transfer (EFT)

 Electronic    
 Remittance  
 Advice (ERA)

 Website Link to Register

 Provider                
 Service Phone #

Before 06/01/2020

PaySpan® Health

 PaySpan®
 Health

www.payspanhealth.com

1-877-331-7154

On or after 06/01/2020

Fidelis Care

 Contact Your
 Clearinghouse

www.fideliscare.org/Provider/Helpful-Tools/Electronic-Transaction

1-888-FIDELIS

(1-888-343-3547)


RESOURCES
Both payers will have a migration section on their provider portals publishing a helpful FAQ, this migration document and many other resource documents. Select and click on the below provider portal links based on the date of service of the claim for all additional detailed resources.

Date of Service

Resource Links

Before 06/01/2020

www.wellcare.com/New-York/Providers/Medicaid

On or after 06/01/2020

www.fideliscare.org


OTHER PROVIDER SERVICE INQUIRIES

For eligibility/benefit information, claim status or other claims-related dispute questions you may have, please choose the appropriate provider service number below. If you have any questions about this message, please feel free to contact WellCare’s EDI Department at EDI-Master@wellcare.com.

Date of Service

Health Plan

Provider Service Phone #

Before 06/01/2020

WellCare of New York, Inc. (Medicaid)

1-800-288-5441

On or after 06/01/2020

Fidelis Care

1-888-FIDELIS
(1-888-343-3547)

 

Sincerely,

WellCare Health Plans, Inc. and Fidelis Care

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

Electronic Transactions

Submit claims electronically with Fidelis Care.

Join Our Provider Network

Be part of the Fidelis Care mission. 

Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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