ᏗᎾᏓᏁᏢᏍᎩ

January 9, 2024

January Capitation Payments to Be Paid by Estimation for Giveback Members

CMS processing error caused MARx to calculate no payments for January

A Centers for Medicare & Medicaid Services (CMS) processing error may have impacted your capitation for January 2024.

There are member discrepancies with the CMS January monthly membership reports (MMRs) causing members to be missing from payment files. These discrepancies impacted Plan-submitted rollover enrollments with a start date of January 2024 that were submitted in October 2023.

Wellcare did not receive payment from CMS for certain Wellcare Giveback members in contract/benefit packages H5087-032 and H5087-033 because of this CMS error. Therefore, our capitation system did not generate payments for independent practice associations and capitated hospitals.

We will be making estimated capitation payments for January and will perform reconciliation when we receive the corrected payments from CMS.

Additional information

If you have questions regarding the information contained in this update, contact 866-999-3945.