August 29, 2025
Dear Provider,
Thank you for your continued partnership with Wellcare of Michigan. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of changes to existing review criteria that will go into place on or after 10/01/25.
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Description of Changes |
Lines of Business |
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Unbundled Treatment Codes: MH/SUD Providers: This correct coding edit’s goal is to look for incorrect coding based on the following scenarios:
Scenario 1: Deny claim billed with codes 80305, 80306, 80307, G0480, G0481, G0482, G0483 if another claim is already submitted/paid billing G2067, G2068, G2069, G2073, G2074, G2075, within 7 calendar days for the same pt and the same provider. Scenario 2: Deny claim billed with codes G2067, G2068, G2069, G2073, G2074, G2075, if another claim is already submitted/paid billing codes 80305, 80306, 80307, G0480, G0481, G0482, G0483 within 7 calendar days for the same pt and the same provider. |
Marketplace & Medicare
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Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.
Sincerely,
Wellcare of Michigan
