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Forms

 Access key forms for authorizations, claims, pharmacy and more.

Appeals & Grievances

Authorizations

Behavioral Health Forms

Behavioral Health Areas of Specialization

A fillable form documenting behavioral health areas of specialization

Helpful Documents


Contains key phone numbers and information on claims, appeals and more.

Claims

Medical Records

Pharmacy

This list includes the most commonly prescribed medications that were on the 2016 formulary and their preferred 2017 alternatives.

Please complete ALL FIELDS and fax this form to WellCare’s Pharmacy Department at 1-866-388-1767.

Please complete ALL FIELDS and fax this form to WellCare’s Pharmacy Department at 1-866-388-1767.

Please complete ALL FIELDS and fax this form to WellCare’s Pharmacy Department at 1-866-388-1767.

Please complete ALL FIELDS and fax this form to WellCare’s Pharmacy Department at 1-866-388-1767.

Please complete ALL FIELDS and fax this form to WellCare’s Pharmacy Department at 1-866-388-1767.

Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.

Fill out and submit this form to request an appeal for Medicare medications.

Other Provider Forms

Instructions for large groups and IPAs with five or more providers on how to register for the secure provider portal.

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Last Updated On: 5/6/2016