WellCare has provided the following information to the clearinghouse:
WellCare wants to encourage providers to submit claims with the correct taxonomy code consistent with the provider's specialty and services being rendered to increase appropriate adjudication. WellCare may reject the claim or pay it at the lower reimbursement rate if the taxonomy code is incorrect or omitted.
WellCare is updating its Medicaid Provider Manual Addendums to reflect further details on state regulatory requirements and standards for submissions of health care claims and encounters, including details on taxonomy code submission. If the provider participates with a State Medicaid program, the provider is registered with taxonomy codes for NPI(s) and those should be used in claim submission.
Valid taxonomy code lists can be found at the link below:
Professional Taxonomy Guidance
When the Rendering Provider is an individual and submitted in the claim, then submit the Rendering Physician's Taxonomy in the 2310B loop within the PRV segment. When the Rendering Provider is the same entity as the Billing Provider, the Rendering Provider loop should be omitted and the Taxonomy should be submitted in 2000A loop with the PRV segment.
Institutional Taxonomy Guidance
Billing Provider Taxonomy should be submitted in 2000A loop with the PRV segment.
For more information, contact WellCare at EDI-Master@wellcare.com or review the WEDI CMS 837 EDI implementation guide.
WellCare payers include:
•CPID 1844 WellCare Health Plan/Staywell
• CPID 8551 WellCare Health Plan/Staywell
•CPID 3211 WellCare Health Plan Encounters
•CPID 4949 WellCare Health Plan Encounters
Action Required: WellCare requests that providers comply with taxonomy submission requirements for claims to be processed in a timely manner and to avoid rejections.
If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
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