COB Medicare Advantage Commercial OHI

5/22/2026

Dear Provider,
Thank you for your continued partnership with Wellcare. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of changes to existing review criteria that will go into place on or after 07/01/2026.

Description of Changes	Lines of Business
COB Medicare Advantage Commercial OHI: Centene Medicare members are secondary payers to Commercial Group Health Plans based on rules outlined in the Concept Synopsis. Cotiviti will identify Medicare Advantage Members that have claims in scope which overlap with Commercial OHI Group Health Plans. Once it is confirmed that Medicare is secondary payer to the Commercial Group Health Plan, Cotiviti will request recoupment of paid claims.	Medicare

Description of Changes

Lines of Business

COB Medicare Advantage Commercial OHI: Centene Medicare members are secondary payers to Commercial Group Health Plans based on rules outlined in the Concept Synopsis. Cotiviti will identify Medicare Advantage Members that have claims in scope which overlap with Commercial OHI Group Health Plans. Once it is confirmed that Medicare is secondary payer to the Commercial Group Health Plan, Cotiviti will request recoupment of paid claims.

Medicare

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

Sincerely,
Wellcare