Claims, eligibility, and reimbursement
Claims and reimbursement resources
File claims and check eligibility with Availity
- Log in to Availity to file claims and check claims and eligibility status for your Wellpoint patients.
- Register for an Availity account (if you do not yet have one).
Reimbursement and administrative policies
The reimbursement policies outline the basis for Wellpoint’s reimbursement of covered services. These policies are meant to help providers submit claims correctly, in accordance with the policies described.
The administrative policies listed below provide additional reimbursement information on services not included with the reimbursement policies:
Fee Schedule Development and Maintenance
Updates to non-participating Ambulatory Surgery Center (ASC) reimbursement policy
Global Surgical Reimbursement Methodology – Facility
Hospital Clinic Visits Facility Reimbursement
Sepsis Clinical Validation Review
SOP for Partial Hospitalization Program and Intensive Outpatient Program
Filing electronic claims
Wellpoint complies with HIPAA 5010 Transaction Standards and Code Sets and with the electronic data interchange (EDI) standards for health care required by the Health Insurance Portability and Accountability Act (HIPAA). EDI is the computer-to-computer transfer of transactions and information. We encourage providers to submit claims electronically to improve productivity and efficiency.
Wellpoint has a strategic partnership with Availity to serve as our designated EDI gateway for all electronic data and transactions. Providers, billing services, and clearinghouses that wish to establish a direct connection can register to exchange EDI transactions at www.availity.com.
Learn more about filing electronic claims
Download this presentation for an outline of provider support tools