Coverage profile
Work Wellpoint 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 Wellpoint.
Supported
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Wellpoint.
Available
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Wellpoint.
Supported
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 Wellpoint.
Available
Other aliases
Also known as
- 14427
- 1775
- 2448
- 2560
- WLPNT
- WLPNTMA
- Amerigroup
- Amerigroup Iowa
- Commonwealth of Massachusetts - GIC
- UniCare
- Wellpoint Insurance Company
- WELLPOINT WEST VIRGINIA
- WELLPOINT DISTRICT OF COLUMBIA
- WELLPOINT HEALTHPLAN OF WV, INC.
- WELLPOINT MARYLAND, INC
- SIMPLY HEALTHCARE PLANS, INC.
- WELLPOINT FLORIDA, INC.
- UNICARE WEST VIRGINIA
- WELLPOINT SOUTH CAROLINA, INC.
2027 maternity billing research
When does Wellpoint change OB/GYN billing?
Confirmed 2027 guidance
Effective January 1, 2027, Wellpoint Maryland Medicaid replaces the global obstetric package with service-level reimbursement. Antepartum care is reported per encounter with the applicable E/M code and modifier TH, and the first prenatal E/M after confirmation must carry a Z3A weeks-of-gestation code. Labor management uses 59080-59083, one per calendar date per setting at the highest level. Delivery uses 59431, 59432, 59502, or 59503 with a Z3A code. Postpartum care is per-encounter E/M with modifier TH, and Z3A is not required on postpartum E/M claims.
- Transition start
- No separate 2026 transition date stated
- Billing start
- 2027-01-01
- Published
- 2026-09-09
- Current As Of
- October 2026
Scope: Wellpoint Maryland, Inc. Medicaid. The New Jersey version of G-14001 is a different document and is not this record's rule.
Reimbursement Policy G-14001: Maternity Services (Maryland Medicaid), approved 09/09/2026, effective 01/01/2027. Verify the payer source before claim submission.
Payer policies
Wellpoint policies
The first 25 of 422 public policies Substrate tracks for Wellpoint, by title. Links open the payer's own document; check its current version before relying on it.
- 2026 Clinical Practice GuidelinesView PDF ↗
- 2026 Clinical Practice GuidelinesView PDF ↗
- 2026 Clinical Practice GuidelinesView PDF ↗
- 2026 Clinical Practice GuidelinesView PDF ↗
- 2026 Clinical Practice GuidelinesView PDF ↗
- 2026 Wellpoint Maryland Provider ManualView PDF ↗
- AbortionView PDF ↗
- Abortion (Termination of Pregnancy)View PDF ↗
- Abortion (Termination of Pregnancy)View PDF ↗
- Abortion (Termination of Pregnancy)View PDF ↗
- Abortion (Termination of Pregnancy)View PDF ↗
- Abortion (Termination of Pregnancy)View PDF ↗
- Advance DirectivesView PDF ↗
- Appointment availability and after-hours access requirementsView PDF ↗
- August 2020 Clinical Utilization Management (UM) GuidelinesView PDF ↗
- August 2021 Clinical Utilization Management (UM) GuidelinesView PDF ↗
- August 2022 Clinical Utilization Management GuidelinesView PDF ↗
- August 2022 Clinical Utilization Management GuidelinesView PDF ↗
- August 2023 Clinical Utilization Management GuidelinesView PDF ↗
- August 2023 Clinical Utilization Management GuidelinesView PDF ↗
- August 2025 Clinical Utilization Management GuidelinesView PDF ↗
- August 2025 Clinical Utilization Management GuidelinesView PDF ↗
- August 2025 Clinical Utilization Management GuidelinesView PDF ↗
- Claims Requiring Additional DocumentationView PDF ↗
- Claims Requiring Additional DocumentationView PDF ↗
Frequently asked questions
Wellpoint payer FAQs
How do I check claim status with Wellpoint?
Providers check Wellpoint via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
Can I automate Wellpoint 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 Wellpoint?
The primary payer ID for Wellpoint is WLPNT. 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 Wellpoint?
The provider portal for Wellpoint is https://apps.availity.com/. Available features depend on the payer and your account.
What are the 837 payer IDs for Wellpoint?
The 837P and 837I payer ID for Wellpoint is WLPNT via Stedi.
What is the 835 payer ID for Wellpoint?
The 835 payer ID for Wellpoint is WLPNT via Stedi.
What is the 270 payer ID for Wellpoint?
The 270 payer IDs for Wellpoint are WLPNT via Stedi and AGPMEDICAID via Availity.
What is the 276 payer ID for Wellpoint?
The 276 payer IDs for Wellpoint are WLPNT via Stedi and AGPMEDICAID via Availity.
What states does Wellpoint operate in?
Wellpoint operates in AZ, IA, NJ, TN, TX, and WA.
Routing reference
Wellpoint 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 | WellpointSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | AZ, IA, NJ, TN, TX, WASource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | WLPNTSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | WLPNTSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | WLPNTEnrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | WLPNTSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | AGPMEDICAIDSource: Availity payer catalog · catalog dated · matched by payer name |
| 276 claim status payer IDStedi | WLPNTSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDAvaility | AGPMEDICAIDSource: Availity payer catalog · catalog dated · matched by payer name |
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: Wellpoint. 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 name; matched record: WELLPOINT. 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: Wellpoint. 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.
Payer contact directory
Wellpoint phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Eligibility / benefits phone
- (800) 526-9202WELLPOINT VISION
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(800) 231-0979 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(800) 243-1401 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(800) 300-7011 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Chiropractic, Hospital, Hospital - Inpatient, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Emergency Services, Professional (Physician) Visit - Office, Professional (Physician) Visit - Office, Physician Visit - Office: Well, Mental Health, Urgent Care |
| phone(800) 341-8478 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 454-3730 | Eligibility / benefits, Utilization managementBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Co-Payment |
| Chiropractic, Chiropractic, Physician Visit - Office: Well, Hospital, Pharmacy, Urgent Care |
| phone(800) 494-6262 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 516-0124 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 521-3605 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(800) 526-9202 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(800) 562-3022 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 723-4337 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(800) 776-6334 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Chiropractic, Dental Care, Hospital, Hospital - Inpatient, Hospital - Outpatient, Hospital - Emergency Accident, Hospital - Emergency Medical, Emergency Services, Pharmacy, Professional (Physician) Visit - Office, Vision (Optometry), Physician Visit - Office: Well, Mental Health, Urgent Care, Mental Health |
| phone(800) 782-0095 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(800) 848-3555 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Chiropractic |
| phone(800) 879-6901 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(800) 888-1965 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Mental Health |
| phone(844) 405-4296 | Eligibility / benefits, Utilization managementBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Co-Payment |
| Hospital, Pharmacy |
| phone(844) 594-5084 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(855) 208-6334 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(855) 230-4656 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(855) 373-7627 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(855) 418-1622 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(855) 934-9812 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(866) 434-5520 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(866) 797-9884 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(866) 805-4589 | Eligibility / benefits, Utilization managementBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Co-Insurance; Benefit context: Co-Payment |
| Chiropractic, Chiropractic, Hospital - Inpatient, Hospital - Outpatient, Physician Visit - Office: Well, Chiropractic, Physician Visit - Office: Well, Pharmacy |
| phone(866) 819-4298 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(866) 864-2526 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(877) 408-0881 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(877) 711-3662 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(888) 291-3766 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(888) 350-3447 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(888) 352-7924 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(888) 554-5542 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(888) 581-3648 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Vision (Optometry) |
| phone(800) 442-9300 | Utilization managementBenefit context: Co-Insurance |
| Hospital |
| phone(844) 594-5072 | Utilization managementBenefit context: Co-Payment |
| Chiropractic |
| phone(866) 655-7423 | Utilization managementBenefit context: Co-Insurance |
| Professional (Physician) Visit - Office |
| phone(215) 241-2400 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(410) 581-3535 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(509) 534-0600 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 421-1362 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 446-5674 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 448-6262 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 523-0582 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 572-7331 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 611-1811 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 632-2022 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 638-6756 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 722-1471 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 810-2583 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 826-9781 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 828-7622 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 832-3211 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 842-5252 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(800) 878-4445 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(833) 531-2238 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(833) 531-2239 | Other stated contextBenefit context: Co-Insurance |
| Hospital |
| phone(866) 350-7598 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(866) 756-3313 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 233-1800 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 392-9865 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 535-2128 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 687-1180 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 687-1196 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(877) 842-3210 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
| phone(888) 898-8145 | Other stated contextBenefit context: Other or Additional Payor |
| Health Benefit Plan Coverage |
Phone and fax numbers sourced directly from the payer response