11/12/2026
Dear Provider,
Wellcare is providing advance notice of an upcoming Payment Integrity review related to certain Durable Medical Equipment (DME) services billed during a member’s inpatient stay.
Effective 01/01/27, applicable supplier-billed DME claims may be reviewed when the date of service overlaps with an inpatient admission. The review is intended to support accurate claim payment consistent with applicable billing requirements, reimbursement guidelines, provider agreements, and Health Plan requirements.
What providers need to know
- Submit claims using applicable billing and coding requirements.
- Maintain documentation supporting the item or service billed.
- Follow applicable Health Plan policies and contractual requirements.
- Use established reconsideration or dispute processes when additional review of a claim determination is needed.
Applicable market-specific requirements or approved exclusions will continue to apply.
Questions
If you have questions regarding this notification or applicable billing requirements, please contact Wellcare Provider Relations.
Thank you for your continued partnership in serving our members.
Sincerely,
Wellcare
