Start-of-Year Billing Guidance for Duals Claims

Date: 02/23/26

As a reminder, all members previously enrolled in our Medicare-Medicaid Plan (MMP) experienced coverage and member ID changes at the start of the calendar year.

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.
• Submit claims for services on or after January 1 using the new Wellcare by Meridian member ID.
• Do not submit claims 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.
• Obtain new prior authorizations for services beginning January 1, 2026, or after from Wellcare by Meridian.
  • Prior authorizations issued under the MMP (prior to January 1, 2026) for dates of service ending on or after January 1 will transfer with the member’s eligibility to Wellcare by Meridian. These authorizations will be honored and do not need to be resubmitted. The authorization number will remain the same.

 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 1-855-445-3571.