Wellcare By Meridian D-SNP Correct Coding and Pre-Payment Edit Update for January 1, 2026

Date: 12/01/25

As part of our continued commitment to supporting providers and ensuring compliance with state and CMS requirements, we are implementing important system changes aligned with our Dual Special Needs Plan (D-SNP), effective January 1, 2026. Please note all current edits will remain in place for MMAI program run out claims.

We are working to implement pre-payment edits for correct coding and payment policies for Wellcare By Meridian D-SNP. The updates will enhance claim accuracy, strengthen policy compliance, and streamline payment processing.

Temporary Process: Post Payment Edits

While implementation work continues, pre-payment edits for correct coding and payment policies are expected to go live in early 2026. Until then, select claims may be subject to post-payment edits rather than pre-payment validations, unless otherwise stated in your contractual agreement.

This approach allows payments to continue without disruption while maintaining oversight through post-payment review. When the edits are activated, any claims paid incorrectly according to policy may be subject to recoupment under standard procedures.

Provider Responsibilities, Reminders, and Next Steps

• Providers are responsible for submitting complete, accurate, and timely billing information to ensure correct payment. Continue to submit claims per the existing guidelines outlined in your provider manual
• Payment integrity teams will issue additional reminders or updates as go-live approaches
• For questions or concerns, please reach out to your Provider Engagement representative

We appreciate your partnership and continued collaboration as we implement improvements to ensure accuracy, efficiency, and compliance with claims processing.