Wellcare By Fidelis Care – Explanation Codes on Dual Access Remittances
2024/5/3
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Posted by Provider Relations
Fidelis Care would like to make you aware new explanation codes you may see on remittances for Wellcare By Fidelis Care Dual Access members:
Explanation Code
- 918 - Member Liability
- The member is responsible for these out-of-pocket cost share amounts.
- 919 - Non-Billable Cost Share
- Do Not Bill Member; for this scenario the member is not liable for the cost share as the amount paid to the provider meets the contractual reimbursement.
- 920 - Bill Cost Share to Medicaid
- For this scenario, the associated cost share needs to be billed to Medicaid.
CARC Code
- 209 – Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)
Please familiarize yourself with these new explanation codes and update your accounts receivable as indicated.
We thank you for your continued partnership in servicing the Wellcare By Fidelis Care membership. If you have questions regarding your remittance advice, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.