The Fidelis Care Blog

As a reminder, effective June 1, 2020, WellCare of New York, Inc. Medicaid, Child Health Plus, Essential Plan, Health and Recovery Plan (HARP), and Managed Long Term Care members will transfer to Fidelis Care.  WellCare Medicare members are not affected by this change.  

* WellCare Medicare members are not affected by this change. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business.  

We want to help your billing department process your claim submissions as efficiently as possible. Please use the date of service guidance on the Provider page of our website to send a claim submission to the correct payer to avoid an eligibility rejection.

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. 

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

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. 

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.

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.

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.

Sincerely,

WellCare Health Plans, Inc. and Fidelis Care