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Wellcare Prior Authorization Changes for Medicare

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.

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

Questions?

Wellcare has a wealth of resources available to help answer your questions and address your Medicare concerns:

 

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Y0020_WCM_164006E_M Last Updated On: 10/1/2024