How to Stop the Flood of WellCare Denials!
As expected, the CMS transition has come with a number of claims and billing-related issues; although none are impossible if you follow some simple steps/rules. To learn about some of the issues we’ve discovered during the transition, you should read our article reviewing the first 60 days under this new program. Once you’ve read that article, it’s time to learn how to fix the issues. In this article we’ll discuss some common ICD-10 diagnosis (DX) code conflicts that will cause denials by WellCare and how to quickly fix your WellCare claims online to get them corrected and paid ASAP!
The following is a list of commonly used pediatric ICD-10 DX codes for ST/OT/PT and codes that are identified as “Mutually Exclusive” with those DX codes; meaning you can’t bill them on the same claim together.
Speech Therapy Common DX Codes:
F80.2: Mutually Exclusive —> H93.25, R47.-, F80.1
F80.0: Mutually Exclusive —> R47.01, R48.2
F80.1: Mutually Exclusive —> R47.-, F80.2
F80.82: Mutually Exclusive —> F84.5, F84.0
F80.89: Mutually Exclusive —> none
R13.12: Mutually Exclusive —> F45.8
R48.2: Mutually Exclusive —> I69.-
Occupational Therapy Common DX Codes:
F81.9: Mutually Exclusive —> none
R62.0: Mutually Exclusive —> none
R62.50: Mutually Exclusive —> none
M62.81: Mutually Exclusive —> M62.84
F88: Mutually Exclusive —> none
F82: Mutually Exclusive —> R26.-, R27.-
Physical Therapy Common DX Codes:
R62.0: Mutually Exclusive —> none
R27.8: Mutually Exclusive —> none
R27.9: Mutually Exclusive —> none
M43.6: Mutually Exclusive —> Q68.0, R29.891, F45.8, G24.3, P15.2
Other Common Therapy DX codes:
F84.0: Mutually Exclusive —> F84.5
Q90.0: Mutually Exclusive —> none
This list is by no means exhaustive and you should refer to “The 2019 ICD-10 CM Complete Official Codebook” for all coding conflicts.
Now that we understand the coding issue, it’s time to go about fixing those WellCare claims and getting paid. We’ve found what we believe is the easiest way to get those claims corrected and paid ASAP. Corrected claims processed on the WellCare provider portal are paying in as few as 5 days from the date you fix the claim. That is unheard of in terms of getting paid for corrected claims so we highly recommend this method.
In order to get started, find your EOBs with claims numbers for all your denied claims. Once you have those, follow the step-by-step process outlined below with the screenshots from the WellCare portal.
We hope this helps you fix your claims quickly and avoid future mistakes.