Wellcare (Kentucky)

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Detail Line Reporting, No Summary.

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Group details (visits and supplies) by Item Date, Revenue Code, HCPCS/CPT, and Description.

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Sort details by Item Date, Revenue Code, HCPCS/CPT, and Description.

Locator

Locator Name

Setup

N/A

General Rules

Select the Suppress dots & dashes in ICD codes, dates and insured info print variation.

FL 4

Type of Bill

Select the Print the bill type as 33X print variation.

FL 6

Statement Cover Period From/Through Dates

Select the Use the first and last Dates of Service print variation.

FL 8

Patient Name/Identifier

Select the Print the middle initial only print variation.

FL 14–15

Admission Type/Point of Origin

Select the Print '3' and '1' Admission Type/Src print variation.

Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.

FL 17

Patient Discharge Status

Select the Print '01' (termination) or '30' (still active) print variation.

FL 31

Occurrence Code

Select the Print '27' occurrence code with admit date print variation.

FL 38

Responsible Party Name

Select the Print the commercial insurance company address print variation.

FL 42–49

Rules for all Claims

Select the following print variations:

N/A

Fee-for-service Claims

Select the following print variations:

FL 43

Revenue Description

Select the Print the supply name from the supply code print variation.

FL 51

Health Plan Identification Number

Select the Only print value for the current claim payer line print variation.

FL 52–53

Release of Information Certification Indicator

Select the Print 'Y' in release and info print variation.

FL 55

Estimated Amount Due

Select the Suppress printing estimated amount due print variation.

FL 60

Insured's Unique ID

Select the Only print value for current claim payer line print variation.

FL 61

Insured's Group Name

Select the Print the Insurance Group Name print variation.

FL 69

Admit Diagnosis

If you select the Print the patient's diagnosis code as of the patient's admission date print variation to report admitting diagnosis for this format used with the Allscripts Homecare 7.2.6.41 or higher version, the claim file will include the admitting diagnosis.

Note: NUBC, CMS, and WEDI have indicated that payers should neither require nor accept claims with the 032X, 033X, 034X, 081X, or 082X type of bill that include the admitting diagnosis because it does not comply with the NUBC UB-04 or 5010 rules. Agencies submitting admitting diagnosis on their claims with the above types of bill could be cited by OESS if a complaint is filed against either the payer or the agency.

FL 81CCa

Code – Code Field

Select the Print agency's Taxonomy Code and ZZ qualifier print variation.

FL 81 CCb

Code – Code Field

Select the Print attending provider's Taxonomy Code and ZZ qualifier print variation.

Field

Description

Assignment of Benefits

and

Release of Information

In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.

Federal Tax ID

-OR-

Social Security Number

-AND-

Provider Taxonomy Code

-AND-
NPI

If your commercial carrier requires reporting attending physician, enter either the physician's federal tax ID.

Enter the provider's taxonomy code.

Enter the physician's NPI.

In addition, the values from the State License, UPIN, and Additional Physician fields may also be reported.

These fields are located in Resource>General>Roles.

Insurance Clearinghouse

In Administration>Financial>Ins Clearinghouse, add a clearinghouse that will be used for the Wellcare claims.

Then, select this clearinghouse in the Clearing House field in Administration>Financial>Insurance Codes>EMC for the insurance code being billed.

Medicare Assign (Medicare Assignment Code)

Enter A or C in Patient>General>Payers>Pay Source>HIPAA. If selected, B is converted to A, and P is converted to C.

Payer Claim Office #

If required by your carrier, indicate the claim office number where the claim will be sent in the Payer Claim Office # field in Administration>Financial>Insurance Companies>Company.

Payer IDs

In Administration>Financial>Ins Clearinghouse>Payer IDs, associate each insurance carrier with payer IDs from the carrier to which you will be submitting claims for Wellcare (KY).

Permitted Home Health Activity

Select the type of the permitted Home Health activity different from Other to submit the information in the electronic file because Other is not a valid value under HIPAA.

Provider ID

Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.

Provider ID Type

To meet HIPAA requirements, for commercial carriers that are Blue Cross/Blue Shield, specify if the provider ID (entered in the Provider ID field) is Blue Cross or Blue Shield in the Provider ID Type field in Administration>Financial>Insurance Companies>Company.

Provider Taxonomy Code

Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General or Administration>Financial>Insurance Companies>Company.

Submitter ID

Enter the value provided to you for this payer or this payer's carrier in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.

Receiver ID

Enter MCC in the Receiver ID (Payer) field in Administration>Financial>Ins Clearinghouse.

Receiver Name

Enter WELLCARE in the Receiver Name field in Administration>Financial>Ins Clearinghouse.

Request for paper EOB

To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.

Text Submission Indicator

Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.