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Coronavirus and the Suspension of Certain Utilization Review Requirements

February 1, 2022

As recommended in New York State Department of Financial Services Insurance Circular Letter No. 1 dated January 6, 2022, Wellcare NY has suspended the following prior authorization requirements for Medicare products:

  • Hospital to Hospital transfer between participating facilities
    • The hospital is expected to use its best efforts to provide notice to Wellcare within 48 hours of the transfer.
    • Please include information necessary for Wellcare to assist in coordinating care and discharge planning.
  • Skilled Nursing Facilities (SNF)
    • Providers will have up to 7 days to notify Wellcare of the admission. 
    • Wellcare will approve the first 7 days of the stay, and will conduct concurrent review for all days beyond day 7.

Wellcare will continue to monitor guidance from New York State.

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Last Updated On: 2/1/2022