11/12/2026
Dear Provider,
Wellcare is providing advance notice of an upcoming Payment Integrity review related to certain Home Health services billed during a member’s inpatient stay.
Effective 01/01/27, applicable Home Health claims may be reviewed when billed for dates that overlap 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 complete and accurate coding.
- Maintain documentation supporting the services provided.
- Review applicable Health Plan policies and contractual requirements.
- Follow established Health Plan processes if you have questions regarding a claim determination.
Where applicable, the review will consider approved exclusions and other requirements established for the member, service, provider, or market.
No action is required solely as a result of this notice. Providers should continue their normal billing practices and follow established Health Plan processes if they have questions regarding a claim determination.
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
