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Medicare Synergy Edits

December 9, 2022

Dear Provider,

Thank you for your continued partnership with Wellcare. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of new policies Wellcare will be implementing effective on or after January 9, 2022.

Initiative Name: Medicare Synergy Edits
Lines of Business: Xcelys Medicare
Description: Implementing correct coding edits in accordance with CMS and AMA guidelines to align. Edits cover the following areas: Durable Medical Equipment, Drugs and Biological, Modifiers, Podiatry, Laboratory-Pathology, Evaluation & Management, Incision and Drainage, Frequency, Bundled Facility, and Vitamin D Testing.

For detailed information about these policies, please refer to our website at wellcare.com/Kentucky/Providers. And for questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team.

Sincerely,

Wellcare

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Y0020_WCM_100876E Last Updated On: 12/9/2022
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