history of the different claims that it had submitted, but WellCare upheld its denial for timely filing.
WellCare’s denial of this claim is in error because the claim was timely filed with WellCare following the Hospital’s receipt of ELCO’s payment. The WellCare provider manual requires a provider to submit a claim to WellCare within 180 calendar days from the date of discharge or inpatient services. However, in the case of an accident that involves no-fault liability insurance, the auto insurer must be billed first as the primary insurer. Then, any balance due after receipt of payment from the primary insurer “should be submitted to WellCare for consideration . . . .” (Provider Manual, pp. 63-65). Importantly, the Provider Manual
WellCare’s denial of this claim is in error because the claim was timely filed with WellCare following the Hospital’s receipt of ELCO’s payment. The WellCare provider manual requires a provider to submit a claim to WellCare within 180 calendar days from the date of discharge or inpatient services. However, in the case of an accident that involves no-fault liability insurance, the auto insurer must be billed first as the primary insurer. Then, any balance due after receipt of payment from the primary insurer “should be submitted to WellCare for consideration . . . .” (Provider Manual, pp. 63-65). Importantly, the Provider Manual