Wellcare would like to provide clarification regarding refraction eye services for Wellcare Medicare members to help providers ensure appropriate access to covered vision services and reduce claim denials.
When utilizing the Wellcare Authorization Lookup Tool, providers may observe that certain refraction-related Current Procedural Terminology (CPT) codes are displayed as covered services. While the service may be covered, the lookup tool does not always indicate when services must be provided through a designated vision vendor.
Important Reminder
For select Wellcare Texas Medicare products, refraction and related eye care services may be managed through Premier Eye Care (Premier), depending on the member's benefit plan and network requirements.
Prior to rendering services, providers should:
- Verify the member's eligibility and benefits.
- Confirm whether services are managed through Premier.
- Ensure that the servicing provider participates in the appropriate network.
- Obtain any required authorizations or referrals based on the member's plan benefits.
Avoid Claim Processing Delays
Rendering services without verifying vendor-specific network requirements may result in:
- Claim denials
- Out-of-network billing issues
- Delays in reimbursement
- Member disruption of care
Provider Resources
Providers are encouraged to verify member-specific benefits and network requirements before services are rendered by utilizing available eligibility and benefit verification resources and contacting Premier when applicable.
For more information regarding member benefits or network requirements, please refer to the Premier Eye Care Quick Reference Guide and Premier Eye Care Provider Manual found on the Wellcare Overview & Resources webpage.
For questions, contact Premier Provider Services (Monday-Friday, 8:00 a.m. to 8:00 p.m.) at 1-855-879-1456.
Thank you for your continued partnership and commitment to delivering quality care to our members.
