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Prior authorization is not required for standard outpatient services. However, other services may require prior authorization, including those offered by non-participating providers. Services requiring authorization include:

  • Residential treatment
  • Acute inpatient hospitalization
  • Partial hospitalization program
  • Intensive outpatient program
  • ECT treatment
  • Assertive community treatment services
  • Psychological testing

Please see our Quick Reference Guide for more information about authorization requirements.

Submit an Authorization

  • Urgent authorizations: Call 1-800-424-5412
  • Inpatient authorization: Fax request to 1-888-361-6574
  • Outpatient authorization: Fax request to 1-888-871-0590

Authorization Requirements

Billing Guidelines

Other Guidelines

WellCare uses nationally accepted guidelines for assessing level-of-care criteria:

  • InterQual™ for behavioral health.
  • American Society for Addiction Medicine (ASAM) for substance abuse.

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Last Updated On: 5/3/2021
WellCare will be performing maintenance on Saturday, September 18, 2021 at 6pm EST until Sunday, September 19, 2021 at 6am EST. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us. ×