Provider Relations

Wellfleet operates a comprehensive PPO offering of student health insurance plans to colleges and universities throughout the country. Our provider efforts help increase quality of care and lower medical costs for Wellfleet Student members. 

Wellfleet has direct relationships with multiple PPO networks at both the national and state levels and utilizes these relationships to ensure plan members receive adequate and appropriate healthcare services.

Our Provider Relations Staff works diligently to assure that our customers receive the most comprehensive service.​

Payment Guidelines

Assistant Surgeons Not Applicable – Effective through 5/31/2021

COVID Tests Payment Guidelines – Effective through 12/31/2020

COVID Tests Payment Guidelines – Effective 1/1/2021

COVID Tests Payment Guidelines – Effective 3/31/2021

COVID Tests Payment Guidelines – Effective through 3/30/2022

Drug Screen – Effective through 8/31/2020

Drug Screen – Effective 9/1/2020

Experimental and Investigational – Effective through 8/31/2020

Experimental and Investigational – Effective 9/1/2020

Experimental and Investigational – Wellfleet E-I Code

Experimental and Investigational – Wellfleet E-I Code – Effective through 9/30/2021

Experimental and Investigational – Wellfleet Unlisted Code – Effective through 9/20/2021

Never Events/Healthcare Acquired Conditions – Effective through 4/30/2020

Never Events/Healthcare Acquired Conditions – Effective 5/1/2021

Never Events/Healthcare Acquired Conditions – Effective 10/1/2021

Platelet-Rich Plasma Injections – Effective through 5/31/2021

Robotic Surgery – Effective through 9/1/2020

Robotic Surgery – Effective through 8/31/2020

Self-Administered Medications – Effective through 12/31/2019

Self-Administered Medications – Effective 1/1/2020

Self-Administered Medications – Effective 7/1/2020

Self-Administered Medications – Effective 7/1/2021

Specialty Drug Reimbursement – Effective through 9/20/2021

Specialty Drug Reimbursement – Effective 10/1/2021 through 1/31/2022

Unlisted Codes – Effective Through 11/30/2020

Unlisted Codes – Effective 12/1/2020

Utilization Review Guidelines

Other Provider Resources

To submit a PPO Pricing Inquiry or Appeal, scan and submit all appeal documentation, including a copy of the claim and EOB, to our Provider Relations team.
To find providers in one of the networks we work with, please click here.
For a copy of the IRS W9 form and provider sheet, click here.
For prior authorization request forms, formularies, and other helpful information, please visit the Forms and Resources page
For questions that cannot be resolved by the network, to submit changes to your IRS W9 form, or to update your provider demographic information, email our Provider Relations team.

Provider Login

Login or create your account to obtain eligibility and claim status information for your patients. On the claim status page, by example, you will see the date a claim was received by Wellfleet, the status of the claim as paid or suspended, the explanation for any suspended claim, or the amount of patient responsibility for any paid claim.

If you have questions please Contact Us.

Provider Search

To find providers in one of our partner networks, visit the link that corresponds with the logo on your ID card.

Get in touch

Whether you’re a current Wellfleet Student member, administrator, or partner — or would like to become one — contact us with any questions you have. We’ll look forward to hearing from you. 

©2022 Wellfleet Group, LLC. All Rights Reserved.

Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.