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InterQual Criteria Rollout

Dear Provider,

We value everything you do to deliver quality care to our members - your patients - and ensuring they have a positive healthcare experience.

As part of the recent Wellcare By ‛Ohana Health Plan Acquisition, effective August 1, 2022, all markets currently utilizing Milliman Clinical Care Guidelines (MCG) will transition to InterQual for Medicare & Medicaid Inpatient Physical Health (Inpatient Admissions, Post-acute Care, Skilled Nursing Facility, Inpatient Rehabilitation, and Long-term Acute Care), Outpatient Physical Health, Inpatient Behavioral Health, and Outpatient Behavioral Health Services.

InterQual’s innovative software offers system-wide solutions that ensure appropriate and cost-effective care for your patients – our members.

For questions or information regarding our policies and procedures, visit our website at www.centene.com. You can also contact your Provider Relations representative.

Thank you for all you do to provide quality care to our members.                

Sincerely,
Wellcare

 

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H9916_WCM 178009E_M Last Updated On: 11/10/2025
Wellcare will be performing maintenance on Saturday, December 13th, from 6 P.M. EDT to 8 A.M. EDT the next day. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us. ×