WellCare Transition to Fidelis Care - Claim Submission, Correspondence and Contact Resources
6/16/2020
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Posted by Provider Relations
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.