Centene Corporation
Centene Corporation (incl. Ambetter Health, Wellcare, and state Medicaid managed care affiliates) · Centene Corporation · NAIC 12831
Where to send the appeal
Verified addresses and inbound channels. We refresh on every release.
Response timeline
The clocks that matter. Miss them and you escalate to the state insurance commissioner.
Codes worth fighting
Based on outcome data across our payer corpus.
- CO-97
- CO-4
- CO-167
- CO-204
- CO-18
- CO-50
- CO-29
- PR-1
- CO-109
Modifier behavior
The denials this payer applies on modifier-bearing claims. The rebuttal language is part of the Denial OS letter generator and not published here.
Modifier 59
Distinct Procedural ServiceCentene's claim editing engine (across Ambetter marketplace and state Medicaid MCO products) flags modifier 59 frequently on therapy and behavioral-health bundling. State Medicaid scope-of-practice rules vary; denials sometimes cite Medicaid-specific edits not present in commercial products.
Modifier 25
Significant, Separately Identifiable E/M ServiceFrequent denial under CO-4/CO-97 on same-day E/M plus procedure billing in both Ambetter ACA and state Medicaid products.
Modifier GT / 95
Telehealth modifiersCentene Medicaid plans inconsistently apply state-by-state telehealth coverage rules; denials often cite missing or incorrect telehealth modifier on covered telehealth services.
Interest statute
The legal basis for charging interest when payment runs late.
Varies by line of business and state — Medicaid MCO prompt-pay rules per 42 CFR 447.46 (90% of clean claims paid within 30 days, 99% within 90 days) / Ambetter ACA marketplace plans subject to state prompt-pay statutes / federal floor under ACA §2719 / 45 CFR 147.136 for non-grandfathered plans
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