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Non-emergent Transportation Crossover Claim Submissions

Effective as of 9/12/2019, WellCare Health Plans of Florida, Inc. and Medical Transportation Management (MTM) are working together to better serve providers who submit Florida member non-emergent transportation Medicare crossover claims for consideration.

The State of FL is currently in a COBA agreement. What is COBA? It is the Coordination of Benefits Agreement between CMS, the Medicare payer and the Medicaid State Agency or Medicaid health plan payer. The Medicare contractor submits the secondary claim on behalf of the provider including the primary payer payment information; Coordination of Benefits (COB) information. The Medicaid payer coordinates these benefits for proper Medicaid adjudication.

What does this mean for providers?  As of today and going forward, providers no longer have to send the FL Medicaid non-emergent transportation portion of COBA crossover claims directly to MTM or WellCare for consideration of reimbursement. WellCare adjudicates COBA submitted crossover clean claim submissions for consideration of reimbursement. Payment consideration is based on WellCare’s Claim Payment Policies*.

We are continuing to evaluate additional opportunities to further streamline the processing of crossover claims and will share additional provider notifications as they are ready for implementation.

* Claim Payment Policies can be found at https://www.wellcare.com under the Resource Section in the Provider Manual.

If you have any further questions or concerns regarding this communication, please contact WellCare Provider Services for the member’s correct plan listed below:

Staywell Medicaid:                                       1-(866) 334-7927 (Mon - Fri, 8 a.m. to 7 p.m. E.S.T)

Children’s Medical Services Medicaid:        1-(866) 799-5321 (Mon - Fri, 8 a.m. to 7 p.m. E.S.T)

Florida Medicare:                                         1-(855) 538-0454 (Mon - Sun, 7 a.m. to 2 p.m. E.S.T)

Thanks,

WellCare Health Plans, Inc.
#44830

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