Providers - Wellfleet Student

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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.

Submit an inquiry or Appeal

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.

Locate a provider

To find providers in one of the networks we work with, please click here.

Download W9 Form

For a copy of the IRS W9 form and provider sheet, click here.

Current Payment Guidelines

• Assistant Surgeons Not Applicable

• Wellfleet Assistant Surgeon List

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

• Drug Screen – Effective 9/1/2020

• Experimental and Investigational – Wellfleet E-I Code

• Experimental and Investigational – Wellfleet Unlisted Code

• Never Events/Healthcare Acquired Conditions

• Platelet-Rich Plasma Injections

• Robotic Surgery – Effective 9/1/2020

• Self-Administered Medications – Effective 1/1/2020

• Self-Administered Medications – Effective 7/1/2020

• Unlisted Codes – Effective 12/1/2020

Old Payment Guidelines

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

• Drug Screen – Effective through 8/31/2020

• Experimental and Investigational – Effective through 8/31/2020

• Experimental and Investigational – Effective 9/1/2020

• Robotic Surgery – Effective through 8/31/2020

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

• Unlisted Codes – Effective Through 11/30/2020

Download New Jersey Appeal Form

• Health Care Provider Application to Appeal a Claims Determination (MS Word)
• Health Care Provider Application to Appeal a Claims Determination (PDF)

Forms & Resources

For prior authorization request forms, formularies, and other helpful information, please visit the Forms and Resources page

Other Inquiries

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.

Cigna

All Other Networks

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. ©2020 Wellfleet Group, LLC. All Rights Reserved.