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Updates to Prior Authorization Requirements: Wound Care and Skin Substitutes

We have an important update to share with you.

Effective April 1, 2020, there will be changes to the authorization requirements for services you may order or render for our members. These authorization changes include all wound care or skin substitute product and application services not related to burns.

On April 1, 2020, WellCare Health Plans, Inc. will be making updates to reflect these changes on the authorization lookup tool www.wellcare.com/auth_lookup. Prior authorization requirements are subject to periodic changes. You should always use our website’s authorization page to determine whether a procedure code requires prior authorization, and always check eligibility and confirm benefits before rendering services to members. Failure to do so may result in denial of reimbursement. 

For questions regarding this notice, please refer to the Quick Reference Guide, and for additional assistance please feel free to contact the Provider Services Dept. The phone number is located in the Quick Reference Guide. When prompted say “Authorizations” or press 2, for assistance.

A combination of criteria may be utilized to establish medical necessity for requested procedures, including but not limited to: WellCare Clinical Coverage Guidelines which can be viewed at https://www.wellcare.com/Mississippi/Providers/Clinical-Guidelines/CCGs/CCG-List..

Thank you for your continued participation and cooperation in our ongoing efforts to provide quality healthcare to our members.


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Last Updated On: 12/3/2020