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Wellcare (Medicare) Pre-Auth

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent upon eligibility, covered benefits, provider contracts and correct coding and billing practices. For specific details, please refer to the Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

Home health services need to be verified by Sunshine Health
Complex imaging, CT, PET, MRA, MRI, and high tech radiology procedures need to be authorized by NIA
Musculoskeletal, Cardiac, ENT and Leg Stent services need to be verified by Turning Point.

 

All out of network requests require Prior Authorization, except emergency care and out-of-area requests.
For non-participating providers, Join Our Network
Services that require prior authorization.

 

Are services being performed in the Emergency Department, or Urgent Care Center, or are the services for dialysis or Hospice?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are anesthesia services being requested for pain management, dental surgery or are services being rendered in an office setting?
Is this an HMO Out of Network service request?

To submit a prior authorization, log in to our Secure Provider Portal.