December 23, 2024
Follow audit letter instructions and send documentation timely to satisfy contractual requirements
Wellcare has contracted with Performant Recovery, Inc. to perform audits of durable medical equipment (DME) claims paid by the Plan.
Why audits are needed
Provider audits are conducted to determine if a provider is conforming to appropriate billing practices and whether the Plan was billed appropriately for medically necessary, covered services. Should overpayments be identified due to this audit, a refund may be owed.
Respond to audit letters timely
As part of the audit process, it will be necessary for providers to send all requested documentation to the address in the audit letters within 30 calendar days from the date of the notice.
- Your response is required even if you are unable to locate the
requested documentation. - If you fail to submit the records within the specified timeframe, the
audit will be cited with a finding due to non-compliance. - Providers retain all appropriate dispute rights if an adverse finding
is received.
BAA adheres to HIPAA
Performant Recovery, Inc. has entered into a Business Associate Agreement (BAA) with the Plan that is in full compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Privacy Rule allows a covered entity to share information, upon request, with another covered entity’s business associate for oversight and auditing purposes, if the request came from that other covered entity.
Additional information
Relevant sections of the Wellcare Provider Manual have been revised to reflect the information contained in this update as applicable. The manual is available online at www.wellcare.com/California/Providers/Medicare.
If you have questions regarding the information contained in this update, contact 1-866‑999‑3945.
