Wellcare has released the latest Prior Authorization (PA) changes for Medicare providers. They will take effect July 1, 2025.
Wellcare is committed to delivering cost effective quality care to our Medicare members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice.
- Download the Medicare Prior Authorization Change Summary (PDF)
Provider Responsibilities
- It is the responsibility of the provider ordering/prescribing services to determine which specific codes require prior authorization.
- Providers must verify a member’s eligibility and benefits before providing medical services. Payment, regardless of authorization, is contingent on the member’s eligibility at the time services are rendered.
- Non-participating providers and facilities require authorization for all HMO services, except where indicated.
Wellcare (Medicare) Pre-Auth Tool
- Sunshinehealth.com/WC-pa: Wellcare providers can use this tool to check Medicare prior authorization requests.
Questions?
Wellcare has a wealth of resources available to help answer your questions and address your Medicare concerns:
- Wellcare Provider Services: Call 1-855-538-0454.
- Secure Provider Portal: Visit Provider.Wellcare.com to check member eligibility, submit claims and more.
- Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
- Provider News: Bookmark Wellcare Provider Bulletins and Sunshine Health Provider News to keep up with the latest updates.
- Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
- Provider Resources: Visit Wellcare.com/flprovider to find provider manuals, important forms, scheduling standards and other provider resources.
