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Targeted Case Management Monthly Limit

11/12/2020

Dear Provider and Staff,

WellCare of Kentucky has some important information to share with you regarding targeted case management billing and payment.

WellCare has discovered that some providers are billing multiple units of targeted case management (HCPCS T2023) per member, per month. As a reminder, reimbursement for targeted case management is a monthly, all-inclusive rate consisting of one unit.

Depending upon the type of targeted case management (substance use disorder, serious mental illness, or a combination of either plus complicating physical health problem), the provider must have four to five TCM contacts with the recipient to quality for reimbursement.

This notice is to remind you that WellCare will only pay for one unit of targeted case management per member per month and will deny any claims exceeding one unit.

Additionally, if you were erroneously paid for more than one unit of TCM for a member for a given month, WellCare intends to recover any such overpayment in accordance with KRS 304.17A-714.

If you have any question regarding this notice, please contact your Provider Relations representative.

Sincerely,

WellCare of Kentucky