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3-Day Payment Window (CC.PP.500)

Thank you for your continued partnership with WellCare of New Jersey. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members.

We are writing today to inform you of changes to our review criteria, as reflected in the policy below. We are removing diagnosis matching criteria in our application of this policy. These changes are effective Oct. 1, 2023.

Summary of Policy:

Policy Number

Policy Name

Policy Description

Lines of Business

CC.PP.500

3-Day Payment Window

The purpose of this policy is to ensure that payment for the technical component of all outpatient diagnostic services and related non-diagnostic services are bundled with the claim for an inpatient stay when services are furnished within 3 calendar days (or, with respect to a non-IPPS hospital, within 1 day) prior to and including the date of the inpatient admission. The bundling requirement does not apply to those services excluded from time to time by Health Plan from this policy, such as ambulance and outpatient maintenance renal dialysis services.

Medicaid

 

We thank you for your commitment to the care and well-being of our members and to the communities we serve.  Should you have any questions or concerns about this notification, please contact us at Provider Services (888) 453-2534. Policies are posted on our website.

Sincerely,
WellCare Health Plans of New Jersey