Timely Filing for Claim Submission and Disputes
Date: 01/31/24
A Message for All Wellcare Providers. Please share with your claims billing and dispute team.
Effective with claim received dates of January 1, 2024, and after, claims timely filing has been updated. This includes timely filing requirements for both Wellcare by Allwell and Wellcare Complete providers.
Timely Filing for Participating Providers
| Wellcare By Allwell | Wellcare Complete | |||
|---|---|---|---|---|
| First time claim submission | 180 days from date of service | First time claim submission | 180 days from date of service | |
| First time claim where Wellcare by Allwell is secondary payor | 180 days from primary EOB paid date | First time claim where Wellcare Complete is secondary payor | 180 days from primary EOB paid date | |
| Corrected claims | 180 days from last EOB paid date | Corrected claims | 90 days from last EOB paid date | |
| First dispute / reconsideration | 180 days from date of decision disputed | First dispute / reconsideration | 90 days from date of decision disputed | |
| Second dispute / reconsideration | 180 days from date of last decision | Second dispute / reconsideration | 90 days from date of last decision | |
Timely Filing for Non-Participating Providers
| Wellcare By Allwell | Wellcare Complete | |||
|---|---|---|---|---|
| First time claim submission | 365 days from date of service | First time claim submission | 365 days from date of service | |
| First time claim where Wellcare by Allwell is secondary payor | 180 days from primary EOB paid date | First time claim where Wellcare Complete is secondary payor | 180 days from primary EOB paid date | |
| Corrected claims | 180 days from last EOB paid date | Corrected claims | 60 days from last EOB paid date | |
| First dispute | None | First dispute / reconsideration | 120 days from date of decision disputed | |
| Second dispute | None | Second dispute / reconsideration | 365 days from date of last decision | |
| Appeal | 60 days with Waiver of Liability (WOL) | Appeal | 60 days with Waiver of Liability (WOL) | |
If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Provider Services at:
- 1-800-977-7522
- D-SNP 1-844-796-6811
- Wellcare Complete 1-800-977-7522
- TTY: 711