Wellcare by Delaware First Health and Wellcare Dual Special Needs Plans (D-SNPs) Pre-Payment Edits starting March 2026

Date: 02/25/26

We are pleased to announce that the previously communicated system enhancements for  Wellcare by Delaware First Health and Wellcare D-SNPs have been finalized. As a result, pre-payment edits will be applied for new claims processed on or after March 15, 2026.

Claims for D-SNP members will now be reviewed and validated prior to payment. This transition is designed to:

• Improve claim accuracy
• Support policy compliance
• Streamline payment processing

Please Note: Claims submitted prior to the pre-pay edit implementation period continue to be subject to post-payment edits, where applicable.  Any claims paid incorrectly according to policy may be subject to recoupment under standard procedures.  

Provider Responsibilities and Next Steps

We value your continued partnership and request that you review the following reminders:

• Continue submitting complete, accurate, and timely billing information, following the guidelines outlined in your provider manual. 
•  Monitor for additional reminders or updates as we approach go-live. If you have any questions or concerns, please reach out to Provider Services at 1-844-536-2169.
• We appreciate your partnership during this transition. Together, we ensure claims are processed accurately and compliantly.  We look forward to continuing to work together to meet State and CMS requirements.