Provider Relations
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.
Independent Dispute Resolution (IDR) Requests: Wellfleet partners with Zelis, Inc. to assist with IDR requests.
For providers who wish to initiate a new No Surprise Act Independent Dispute Resolution (IDR) request, or have a question about an in process/open IDR request, please email your request to: [email protected]
For providers who wish to initiate a negotiation on a No Surprise Act claim, please email your request to: [email protected].
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
• DRG Readmissions – Effective 7/2/2024
• Drug Screen – Effective 9/1/2023
• Experimental and Investigational – Effective 11/1/2024
• Attachment A: Experimental and Investigational Code List – Effective 11/1/2024
• High Cost Drug Reimbursement Guideline – Effective 12/20/2024
• Attachment A: High Cost Drug Code List – Effective 12/20/2024
• Never Events/Healthcare Acquired Conditions – Effective 1/12/2024
• Pharmacist Reimbursement for Medical Services – Effective 9/1/2024
• Platelet-Rich Plasma Injections – Effective 11/1/2024
• Robotic Surgery – Effective 10/1/2024
• Self-Administered Medications – Effective 7/1/2024
• Surgeon Modifier Reimbursement – Effective 3/1/2025
• Surgeon Modifier Reimbursement Codes – Effective 3/1/2025
• Unlisted Codes – Effective 11/1/2024
•Assistant Surgeons Not Applicable – Effective through 2/28/2025
• Wellfleet Assistant Surgeon Code List – Effective through 2/28/2025
• COVID Tests Payment Guidelines – Effective through 5/11/2023
• COVID Tests Payment Guidelines – Effective through 8/15/2024
• Drug Screen – Effective through 7/31/2022
• Drug Screen – Effective 8/31/2022
• DRG Readmissions – Effective 7/1/2023
• Experimental and Investigational – Effective 9/1/2022
• Experimental and Investigational – Effective through 8/1/2023
• Experimental and Investigational – Effective through 10/31/2024
• High Cost Drug Reimbursement Guideline – Effective through 1/31/2024
• Attachment A: High Cost Drug Code List – Effective through 1/31/2024
• High Cost Drug Reimbursement Guideline – Effective through 12/19/2024
• Attachment A: High Cost Drug Code List – Effective through 12/19/2024
• Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective through 8/31/2022
Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective 8/31/2023
• Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective through 10/31/2024
• Modifier CS Payment Guideline – Effective 11/01/2023
• Never Events/Healthcare Acquired Conditions – Effective through 9/30/2022
• Never Events/Healthcare Acquired Conditions – Effective through 1/11/2024
• Platelet-Rich Plasma Injections – Effective through 8/31/2022
• Platelet-Rich Plasma Injections – Effective through 1/24/2023
• Platelet-Rich Plasma Injections – Effective through 10/12/2023
• Platelet-Rich Plasma Injections – Effective through 10/31/2024
• Robotic Surgery – Effective through 9/30/2022
• Robotic Surgery – Effective through 9/30/2024
• Self-Administered Medications – Effective through 12/31/2022
• Self-Administered Medications – Effective through 6/30/2023
• Self-Administered Medications – Effective through 10/12/2023
• Self-Administered Medications – Effective through 10/13/2023
• Self-Administered Medications – Effective through 6/30/2024
• Specialty Drug Reimbursement – Effective through 7/31/2023
• Attachment A Specialty Drug Reimbursement – Specialty Drug Code List – Effective through 7/31/2023
• Unlisted Codes – Effective through 8/31/2022
• Unlisted Codes – Effective through 2/28/2023
• Unlisted Codes – Effective through 9/30/2023
• Unlisted Codes – Effective through 10/31/2024
• Attachment A: Unlisted Codes – Effective through 10/31/2024
• Attachment B Wellfleet Unlisted Code — Effective through 8/31/2022
• Attachment B Wellfleet Unlisted Code List Effective through 9/30/2023
• Vaccine Consultation Fee – CT Plans – Effective through 12/31/2022
• Vaccine Consultation Fee – CT Plans – Effective 1/1/2023
• Pharmacist Reimbursement for Medical Services – Effective through 8/31/2024
• Attachment A: High Cost Drug Code List – Effective through 9/30/2024
Utilization Review Guidelines
Other Provider Resources
Wellfleet & State Specific PA Forms (non-electronic submission)
- AZ – Prior Authorization Form
- FL – Prior Authorization Form
- IN – Prior Authorization Form
- NM – Prior Authorization Form
- RI – Prior Authorization Form
- TX – Prior Authorization Form
- VT – Prior Authorization Form
- Wellfleet – Prior Authorization Form
- Wellfleet Retrospective Review Form
Cigna & State Specific PA Forms (non-electronic submission)
Hines & State Specific PA Forms (non-electronic submission)
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
- 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.
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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.