August 1, 2022
Dear Valued Provider,
To reduce administrative burden on our provider partners, Wellcare is making the following changes to our peer-to-peer review request requirements. This will impact peer-to-peer requests received on or after October 1, 2022.
Peer-to-Peer Review Requests:
In order to ensure accurate delivery and reimbursement for medically necessary services to our members, Wellcare is updating our requirements for peer-to-peer review to the following:
- Peer-to-peer review requests will be allowed up to two (2) business days after Integrated Denial Notice or day of discharge, whichever is later.
- Peer-to-peer outreach will be completed within 2 business days of peer-to-peer review request.
- If provider is not reached, a voice mail will be left (if possible) giving provider one business day to respond.
- If the provider does not respond within the stipulated timeframe, Wellcare will be unable to proceed with peer-to-peer request.
No changes are being made to existing peer-to-peer timeframes or processes for pre-service requests.
Thank you for continuing to provide our Medicare members with high quality and compassionate care. If you have questions about any of this information, please contact Provider Services.