Medicare
- Important Pharmacy Claims Processing Change, Effective January 1, 2024
- Medicare Prior Authorization Changes Effective October 1, 2023
- Annual Special Needs Plan Model of Care (MOC) Training
- Review Criteria Change: 72 Hour Rule Enhancement
- Reminder: Home Health Notice of Admission (NOA) Change
- Termination of Somatus Care Management Program for Patients with CKD/ESRD
- COVID-19 Public Health Emergency (PHE) Expiration - Effective May 11, 2023
- Medicare Prior Authorization Change Summary - Effective July 1, 2023
- Appendix A - Medicare Part B Drug List - Effective July 1, 2023
- MSK Notification of New Authorization
- Reminder of CMS Lab Ordering Guidelines
- Guidance on Effective Date for Legacy Wellcare Medicare ID Cards
- Wellcare 2023 $0 Immunizations Part D Vaccines - (PDF)
- Special Needs Plan Model of Care Self-Study Program
- Medicare Part B Drugs List: Effective January 1, 2023 (Appendix A)
- Medicare Prior Authorization Change Summary: Effective January 1, 2023
- Special Supplemental Benefits for the Chronically Ill Attestation: Process Change
- CMS Lab Ordering Guidelines Reminder
- NIA Sympathetic Nerve Block Notification Letter
- Sneak Preview of 2023 Improvements
- Medicare Correct Coding Edits Effective November 1, 2022
- Medicare Provider CMS NPPES Program Update
- Peer-to-Peer Review Request Requirement Changes Effective September 1, 2022
- InterQual Criteria Rollout: Effective August 1, 2022
- Prior Authorization Change Summary: Effective July 1, 2022
- Medicare Billing Tips for Transplant Service Claims
- Medicare PPO Provider Billing Flyer
- Prior Authorization Requirement Updates: Effective March 1, 2022
- Medicare Billing Updates Effective January 1, 2022
- 2022 Formulary Change Notification
- Wellcare’s Provider Portal – Providers love our Live Chat!
- New Ophthalmology Medical Necessity Payment Policies
- Wellcare’s Provider Portal – Now with Improved Live Chat
- Point of Care Formulary Information Tools
- CPP 161: Polymerase Chain Reaction Respiratory Viral Panel Testing
- New Somatus Care Management Program for patients with CKD/ESRD
- Claims and Payment Policy: Review of NOS, NEC, & Unlisted Codes
- Provider IVR Claims Menu Redesign
- New Portal Features: iCarePath Claim Appeals and Disputes
- New Prepay Edits: Institutional Ambulance Claims
- Wellcare is launching PPO Plans in select NJ counties in 2021
- Prepayment Clinical Validations Edit Policy
- CCG: Short Inpatient Hospital Stays Effective October 1, 2020
- Appropriate Place of Service (POS) Billing
- CPP 151: Frequency of Comprehensive Ophthalmological Exams
- $0 Member Liability extended for select services until end of 2020
- CPP 145: Incorrect Billing for Severe Malnutrition Policy
- Revised ED Outpatient Facility EM Coding Policies
- Opioid Program MAT Certification
- Prior Authorization Updates: Wound Care and Skin Substitutes
- CPP 133: 340B Drug Payment Reduction Policy
- NJ Health offers resources for diagnosis/treatment of COVID-19
- New Medicare ID cards for 2020
- Newark Water Crisis & Lead Poisoning
- Dialysis Claims Payment Policy
- Reducing Low Value Care Screenings Claims Edit Guidelines Policy
- Intensity-Modulated Radiation Therapy (IMRT) Reimbursement Policy
- ED High Acuity Radiology Utilization Reimbursement Policy
- Post-Payment Technical Denial Enforcement
- Medicare Milliman Clinical Guidelines (MCG) Rollout
- New Urine Drug Testing Guidelines
- Prior Authorization Requirements
- Medicare Star Ratings Call to Action
- Annual Wellness visit and Additional Annual Physical Coding Refresher
- Readmission Policy Update
- New Modifier Claims Edit Guideline (CEG)
- Prior Authorization Requirements
- Dual SNP Cost Share Update
- Important Update to the Post-Acute Care CCG
- HealthHelp
- New Medicare Cards
- Exciting Authorization Rule Enhancements
- Your Partner in Quality Care
- Pharmacy Benefit Manager Effective January 1, 2016
- ICD-10 Transition Effective October 1, 2015
- Inpatient Readmission Policy
- Coding Reminder: Modifier 25
