Start-of-Year Billing Guidance for Duals Claims

Date: 01/20/26

As a reminder, some members experience coverage and member ID changes at the start of the calendar year, including those who are enrolled in one of our duals plans.

Claims for services rendered on or after January 1, 2026, must be submitted using the current year member ID. Please follow the steps below to avoid rejected claims and processing delays:

• Verify eligibility to confirm the members' current coverage and member ID.
• Obtain new authorization when required for services beginning in the new year.
• Submit claims for services on or after January 1 using the new Wellcare by Delaware First Health member ID.
• Do not submit claims for dual-eligible members that span December and January for dates of service under a single claim. Claims must be split and submitted under the corresponding plan for 2025 or 2026.

You may verify eligibility through our secure provider portal or Availity Essentials. If you have questions regarding a specific member’s eligibility or coverage, call Provider Services at 1-844-536-2169.