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Exciting Authorization Rule Enhancements

***Correction: You may have received a previous version of this letter describing changes taking place on Jan. 27, 2018. The changes will take place on Feb. 24, 2018. We apologize for the inconvenience this may have caused.***

The WellCare Group of Companies recently made enhancements to our Medicare authorization requirements, and now we are excited to announce some important outpatient prior authorization requirement changes for our Medicaid product as well! We are reducing the amount of Medicaid services/procedures requiring prior authorization. These updates are designed to help ease your day-to-day interactions with us while allowing us to continue to exercise responsible stewardship over the government funded health care programs we administer.

For dates of service on or after Feb. 24, 2018, we are standardizing authorization requirements across ALL outpatient places of service for our Medicaid services.  

  • Other UM thresholds and rules such as high dollar DME claims will continue although we have increased some of the thresholds.

On Feb. 24, 2018, will be updated to reflect these changes. Prior authorization requirements are subject to periodic changes.  You should always use our website’s authorization page to determine if a procedure 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 contact Provider Services at the number located on your Quick Reference Guide and when prompted say Authorizations or press 2.

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members. 

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Last Updated On: 12/4/2020
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