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UniCare Massachusetts is now Wellpoint, effective July 1, 2024. New name, same commitment to you.

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Claims, eligibility, and reimbursement

Claims and reimbursement resources

File claims and check eligibility with Availity

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

 

  Global Surgical Reimbursement Methodology – Facility

 

  Hospital Clinic Visits Facility Reimbursement

 

  Sepsis Clinical Validation Review

 

  Hospital At Home (HAH)

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