Skip to main content

New Modifier Claims Edit Guideline (CEG)

Summary of Change:

WellCare has added a Claims Edit Guideline (CEG) for procedure-to-procedure associated modifiers. Please share this notice with other members of your practice and office staff.

What does this mean for providers?

Beginning May 15, 2018, our clinical teams will use the Modifier CEG to ensure the extent and nature of the services rendered for a patient’s condition, as well as verify the claim is coded correctly for the services billed. Therefore, providers may experience an increase in requests for medical record submissions when billing modifiers, including 24, 25, 59, XE, XP, XS or XU.

Why is WellCare implementing this policy?

The intent of this change is to ensure appropriate use of modifiers upon claim submissions. Once the requested medical records are received and reviewed, WellCare will approve final payment if claims have appropriately used the referenced modifiers.


Contact Us icon

ᎤᏚᎸᏓ ᎠᏍᏕᎸᏗᎢ? ᎠᎭᏂ ᎣᏤᏙ ᏂᎯ ᏳᏰᎵᏗ.

ᎢᏍᎩᏟᏃᎮᏓ ᏂᎦᏓ
Last Updated On: 8/7/2018
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.

×