Coverage profile
Work Wellcare across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Wellcare.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Wellcare.
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Wellcare.
Appeals agent
AI appeals workflowThe Substrate Appeals Agent can submit appeals for RFIs, medical record requests, downcoding reconsiderations, and more via the payer portal for Wellcare.
Other aliases
Also known as
- 100842
- 10488
- 10510
- 10511
- 10512
- 10513
- 10515
- 10576
- 10921
- 10944
- 1119
- 11216
- 14163
- 14163MA
- 14164
- 16559
- 1844
- 48055
- 57116
- 59608
- 62153
- 8041
- 8551
- 9529
- 9759
- 9762
- RFVSD
- SNICI
- TH118
- TX1ST
2027 maternity billing research
When does Wellcare change OB/GYN billing?
CC.PP.016 describes global maternity bundling and prepayment code review. It applies to adopting health plans on their own effective dates and contains no 2027 code-deletion implementation instructions.
- Transition start
- No 2027 transition date stated in cited policy
- Billing start
- No 2027 billing date stated in cited policy
- Published
- Not stated in source
- Current As Of
- August 2026
Scope: Corporate template for medical maternity services; adoption and effective date must be verified for each Wellcare state, program and product. No dental or vision billing application is established.
CC.PP.016 Reporting the Global Maternity Package. Verify the payer source before claim submission.
Payer policies
Wellcare policies
The first 25 of 319 public policies Substrate tracks for Wellcare, by title. Links open the payer's own document; check its current version before relying on it.
- Air Ambulance: CP.MP.175View PDF ↗
- Air Ambulance: CP.MP.175View PDF ↗
- Air Ambulance: CP.MP.175View PDF ↗
- Allergy Testing and TherapyView PDF ↗
- Allergy Testing and TherapyView PDF ↗
- Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia: CP.MP.108View PDF ↗
- Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and β-Thalassemia: CP.MP.108View PDF ↗
- Allogeneic Hematopoietic Cell Transplants: CP.MP.108View PDF ↗
- Allogeneic Hematopoietic Progenitor Cell Therapy: CP.MP.249View PDF ↗
- Applied Behavior Analysis: CP.BH.104View PDF ↗
- Applied Behavioral Analysis Documentation Requirements: CP.BH.105View PDF ↗
- Applied Behavioral Analysis Documentation Requirements: CP.BH.105View PDF ↗
- Applied Behavioral Analysis: CP.BH.104View PDF ↗
- Aquatic Therapy: HI.CP.MP.500View PDF ↗
- Articular Cartilage Defect Repairs: CP.MP.26View PDF ↗
- Attention Deficit Hyperactivity Disorder Assessment and Treatment: CP.BH.124View PDF ↗
- Attention Deficit Hyperactivity Disorder Assessment and Treatment: CP.BH.124View PDF ↗
- Bariatric SurgeryView PDF ↗
- Behavioral Health Treatment Documentation Requirements: CP.BH.500View PDF ↗
- Behavioral Health Treatment Documentation Requirements: CP.BH.500View PDF ↗
- Behavioral Health Treatment Documentation Requirements: CP.BH.500View PDF ↗
- Biofeedback : CP.MP.168View PDF ↗
- Biofeedback for Behavioral Health DisordersView PDF ↗
- Biofeedback: CP.MP.168View PDF ↗
- Biofeedback: CP.MP.168View PDF ↗
Frequently asked questions
Wellcare payer FAQs
How do I check claim status with Wellcare?
Providers check Wellcare via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
Can I automate Wellcare portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Wellcare?
The primary payer ID for Wellcare is 14163. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the provider portal for Wellcare?
The provider portal for Wellcare is https://apps.availity.com/. Available features depend on the payer and your account.
What are the 837 payer IDs for Wellcare?
The 837P and 837I payer ID for Wellcare is 14163 via Stedi.
What is the 835 payer ID for Wellcare?
The 835 payer ID for Wellcare is 14163 via Stedi.
What is the 270 payer ID for Wellcare?
The 270 payer IDs for Wellcare are 14163 via Stedi and 14163 via Availity.
What is the 276 payer ID for Wellcare?
The 276 payer IDs for Wellcare are 14163 via Stedi and 14163 via Availity.
Routing reference
Wellcare payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | WellcareSource: Substrate payer directory · data last changed |
|---|---|
| 837P professional claims payer IDStedi | 14163Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 14163Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 14163Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 14163Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | 14163Source: Availity payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDStedi | 14163Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDAvaility | 14163Source: Availity payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Wellcare. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer ID; matched records: AMERICAN PROGRESSIVE, CENTRAL SENIOR CARE, EASY CHOICE HEALTH PLAN CALIFORNIA, FIDELIS CARE NEW JERSEY, FIRST CHOICE HEALTHPLANS OF CONNECTICUT, FRESENIUS MEDICAL CARE, GENERATIONS, GOLDEN TRIANGLE PHYSICIAN ALLIANCE SELECTCARE TEXAS, HARMONY HEALTH PLAN, HEALTHEASE, HEALTHEASE KIDS, HERITAGE PHYSICIAN NETWORK (HOUSTON), KATY MEDICAL CLAIMS, KATY MEDICAL GROUP, MED3000 CMS TITLE 19 REFORM, MED3000 CMS TITLE 21, MEMORIAL CLINICAL ASSOCIATES SELECTCARE TEXAS, MISSOURI CARE MC, NORTHWEST DIAGNOSTIC CLINIC SELECTCARE TEXAS, OHANA HEALTH PLAN, PINNACLE PHYSICIAN MANAGEMENT, SELECT CARE HEALTH PLAN HMO (NTX), SELECT CARE HEALTH PLAN HMO (TOPA), SELECT SENIOR CLINIC, SELECTCARE OF TEXAS (BEAUMONT), SELECTCARE OF TEXAS (HOUSTON), SELECTCARE OF TEXAS (KELSEY-SEYBOLD), SELECTCARE TEXAS (HPN) HERITAGE PHYSICIANS NET, SELECTCARE TEXAS ALLIANCE (KELSEY SEYBOLD GTPA), STAYWELL, STAYWELL KIDS, TEXAN PLUS (BEAUMONT), TEXAN PLUS (HOUSTON), TEXAN PLUS (KELSEY-SEYBOLD), TEXAN PLUS-SELECTCARE OF TX (KELSEY-SEYBOLD), TEXANPLUS (SOUTHEAST TEXAS AREA), TEXAS FIRST HEALTH PLAN (NORTH TEXAS), TEXAS FIRST HEALTH PLAN NORTHTX (SELECT CARE HEALTH PLAN HMO (TOPA), TEXAS FIRST HEALTH PLAN NTX, TEXAS FIRST HEALTH PLANS (TOPA), TEXASFIRST HEALTH PLANS (TIOPA), TEXASPLUS SE, TEXASPLUS_SE, TODAYS HEALTH, TODAYS OPTIONS (AMERICAN PROGRESSIVE & PYRAMID HEALTH), TODAYS OPTIONS (AMERICAN PROGRESSIVE AND PYRAMID LIFE), TODAYS_HEALTH, TRIBUTE (SELECTCAREOK), UNIVERSALAMERICAN, VILLAGE FAMILY PHYSICIAN, WELLCARE, WELLCARE HEALTH PLANS, WELLCARE HMO, WELLCARE ILLINOIS, WELLCARE MICHIGAN, WELLCARE NEW YORK, WELLCARE OF CA, WELLCARE OF CONNECTICUT, WELLCARE OF FLORIDA, WELLCARE OF GEORGIA, WELLCARE OF MICHIGAN & WELLCARE OF ILLINOIS, WELLCARE OF NEBRASKA, WINDSOR HEALTH PLAN. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
- United Clearinghouse payer catalogMatched by payer name; matched record: Wellcare. The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.