Provider Relations
Increased quality of care and lower medical costs for Wellfleet Workplace health plan members: That’s what our Provider Relations Team delivers.
Wellfleet has direct relationships with multiple PPO networks at both the national and state levels and utilizes these relationships to ensure plan members receive the most appropriate and comprehensive healthcare services available to them.
Payment Guidelines
• Drug Screen – Effective 8/1/2022
• Experimental and Investigational – Effective 9/1/2022
• Attachment A Experimental and Investigational — Wellfleet E-I Code — Effective 9/1/2022
• Modifier CS Payment Guideline – Effective 11/1/22
• Never Event Payment Guideline – Effective 10/1/22
• Platelet-Rich Plasma Injections – Effective 1/25/2023
• Robotic Surgery Payment Guideline – Effective 10/1/22
• Unlisted Codes – Effective 3/1/2023
• Assistant Surgeons Not Applicable – Effective through 6/1/2022
• Wellfleet Assistant Surgeon List – Effective through 6/1/22
• Assistant Surgeons Not Applicable – Effective through 5/31/2021
• Assistant Surgeons Not Applicable – Effective through 6/1/2022
• Wellfleet Assistant Surgeon List – Effective through 6/1/2022
• Drug Screen – Effective through 8/31/2020
• Drug Screen – Effective through 8/31/2021
• Drug Screen – Effective through 7/31/2022
• Experimental and Investigational – Effective through 8/31/20
• Experimental and Investigational – Effective through 9/30/2021
• 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 8/31/2020
• Robotic Surgery – Effective through 8/31/2021
• Robotic Surgery – Effective through 9/30/2022
• 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 through 9/30/2021
• Specialty Drug Reimbursement – Effective 10/1/2021 through 1/31/2022
• Experimental and Investigational – Wellfleet Unlisted Code
• Unlisted Codes – Effective through 8/31/2022
• Unlisted Codes – Effective through 2/28/2023
• Vaccine Consultation Fee – CT Plans – Effective through 12/31/2022
Utilization Review Guidelines
Other Provider Resources
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.
For a copy of the IRS W9 form and provider sheet, click here.
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 Search
To find providers in one of our partner networks, visit the link that corresponds with the logo on your ID card.
1500 Main Street, Suite 1000, Springfield, MA 01115-5369
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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.