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.
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 8/15/2023
• Wellfleet Assistant Surgeon Code List – Effective 8/15/2023
• COVID Tests Payment Guidelines – Effective 5/12/2023
• DRG Readmissions – Effective 7/1/23
• Drug Screen – Effective 9/1/2023
• Experimental and Investigational – Effective 9/1/2023
• Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective 9/1/2023
• Never Events/Healthcare Acquired Conditions – Effective 10/1/22
• Platelet-Rich Plasma Injections – Effective 10/13/2023
• Robotic Surgery Payment Guideline – Effective 10/1/22
• Self-Administered Medications – Effective 10/13/2023
• High Cost Drug Reimbursement Guideline – Effective 8/1/2023
• Attachment A: High Cost Drug Code List – Effective 8/1/2023
• Unlisted Codes – Effective 3/1/2023
• Attachment B Wellfleet Unlisted Code List Effective 9/1/2022
• 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 8/31/2023
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 9/30/2022
• 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 10/12/2023
• 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
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)
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.
©2023 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.