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Reclamos

Wellcare By ‘Ohana Health Plan 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.

Reimbursement Policies

From time to time, we review our reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies.

 

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.

Companion Guides

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

Other Resources

Reference Guides


Contains key phone numbers and information on claims, appeals and more.

Ícono de contacto

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Last Updated On: 11/1/2024
El 21 de febrero de 2024, Change Healthcare sufrió un incidente de ciberseguridad. Toda persona afectada por este incidente recibirá una carta por correo. Obtenga más información sobre este incidente de Change Healthcare o comuníquese con el centro de contacto al 1-866-262-5342. x
Wellcare will be performing maintenance on Saturday, December 21, from 6 P.M. EDT to 8 A.M. EDT the next day. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us. ×