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Policy and Procedure

Does Wellcare use the Center for Medicare & Medicaid Services (CMS) ICD-10 General Equivalency Maps (GEMs) crosswalks?
General Equivalency Maps (GEMs) were used along with Wellcare custom clinical and coding mappings to address gaps in GEMs during the transition.

Did Wellcare's pre-authorization policy and/or guidelines for requesting pre-authorizations change with the implementation of ICD-10?
All claims are dependent upon a valid diagnosis code being submitted. Wellcare has the ability to auto-adjudicate ICD-10 claims in the same manner we auto-adjudicated ICD-9 claims.

Did Wellcare update medical review policies to support ICD-10?
All medical policies were reviewed for the ICD-10 transition. Providers may access Wellcare's Clinical Coverage Guidelines.

What percent of claims processed and paid claims are based on ICD codes?
All claims processed and paid are based upon procedure code fee schedules or Optum Pricers Dollar amount is driven by either the CPT, HCPC, Rev Code or DRG assigned to the claim.

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Última actualización:132/1/2020
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.