Provider Relations

Important Message Regarding Change Healthcare

March 8, 2024

On February 21, 2024, Change Healthcare identified a cybersecurity incident. Wellfleet partners with Change Healthcare as its claims clearing house for claims submitted under payer id 87843.

We are working to set up an alternative clearing house solution but in the meantime, to prevent payment delays we encourage Providers to send claims via:

For questions, please contact:

Customer Service: [email protected] | 877-657-5030

Note that the following functions were not affected by the cyberattack and continue to be available with no changes: Prior Authorizations, Utilization Management, Benefit Verifications, Appeals and Grievances.

For more information, review Change Healthcare’s statement on its website by clicking here.

Wellfleet is committed to the health of our members and will work with providers who are impacted to ensure services can continue to be provided.

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.


Massachusetts Bulletin 2024-02 – Annual Mental Health Wellness Exams Applicable to Wellfleet Massachusetts SHIP Plan Members:

Wellfleet provides coverage for an annual mental health wellness examination that is performed by a licensed mental health professional or primary care provider, which may be provided by the primary care provider as part of an annual preventive visit. This benefit will be provided once every 12 months at no cost to the member. Wellfleet partners with the Cigna Network for provider network services. Cigna notified their contracted providers about this requirement.  If Providers have questions regarding this requirement, please contact the Wellfleet Provider Relations Team at [email protected].  

For additional information regarding this requirement, please refer to MA DOI Bulletin 2024-02 which can be found here.

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

Assistant Surgeons Not Applicable – Effective through 6/1/2021

Assistant Surgeons Not Applicable – Effective through 6/1/2022

Wellfleet Assistant Surgeon List – Effective through 6/1/22

Wellfleet Assistant Surgeon List – Effective through 6/1/2022

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

COVID Tests Payment Guidelines – Effective through 1/1/2021

COVID Tests Payment Guidelines – Effective through 9/30/2021

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

COVID Tests Payment Guidelines – Effective through 5/11/2023

Drug Screen – Effective through 8/31/2020

Drug Screen – Effective through 8/31/2021

Drug Screen – Effective through 7/31/2022

Drug Screen – Effective 8/31/2022

Experimental and Investigational – Effective 9/1/2022

Experimental and Investigational – Effective through 8/31/2020

Experimental and Investigational – Effective through 9/30/2021

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

Experimental and Investigational – Effective through 8/1/2023

High Cost Drug Reimbursement Guideline – Effective through 1/31/2024

Attachment A: High Cost Drug Code List – Effective through 1/31/2024

Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective 8/31/2023

Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective through 8/31/2022

Modifier CS Payment Guideline – Effective 11/01/23

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

Never Events/Healthcare Acquired Conditions – Effective through 9/30/2021

Never Events/Healthcare Acquired Conditions – Effective through 9/30/2022

Never Events/Healthcare Acquired Conditions – Effective through 1/11/24 

Platelet-Rich Plasma Injections – Effective through 10/12/2023

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

Platelet-Rich Plasma Injections – Effective through 8/31/2022

Platelet-Rich Plasma Injections – Effective through 1/24/2023

Robotic Surgery – Effective through 9/1/2020

Robotic Surgery – Effective through 8/31/2020

Robotic Surgery – Effective through 9/30/2022

Self-Administered Medications – Effective through 10/13/2023

Self-Administered Medications – Effective through 10/12/2023

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

Self-Administered Medications – Effective through 6/30/2020

Self-Administered Medications – Effective through 6/30/2021

Self-Administered Medications – Effective through 7/31/2021

Self-Administered Medications – Effective through 6/30/2022

Self-Administered Medications – Effective through 12/31/2022

Self-Administered Medications – Effective through 6/30/2023

Specialty Drug Reimbursement – Effective through 9/20/2021

Specialty Drug Reimbursement – Effective through 7/31/2023

Attachment A Specialty Drug Reimbursement – Specialty Drug Code List – Effective through 7/31/2023

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

Unlisted Codes – Effective Through 11/30/2020

Unlisted Codes – Effective through 8/31/2021

Unlisted Codes – Effective through 2/28/2023

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

Unlisted Codes – Effective through 8/31/2022

Attachment B Wellfleet Unlisted Code — Effective through 8/31/2022

Vaccine Consultation Fee – CT Plans – Effective through 12/31/2022

Vaccine Consultation Fee – CT Plans – Effective 1/1/2023

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.

  • Click here to request access to register for Wellfleet’s ePayment Center. Once you receive your registration code you will be able to register. Please allow 3 business days. Include the following in your email: 
    • Provider name
    • Email
    • NPI #
    • Tax ID #
  • Click here to register with the ePayment Center to receive ERAs and EFTs at no cost to you after you have received your registration code.
  • ePayment Center Welcome Kit Brochure
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. 

©2024 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.