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Access key forms for authorizations, claims, pharmacy and more.
Use this form to appoint an individual to act as a representative.
Use this form to file an appeal or dispute based on a claim outcome.
Wellcare Provider Payment Dispute Request Form
Non-Par Provider Payment Dispute Request Form
Wellcare Participating Provider Reconsideration Request Form
Non-Par Non Par Reconsideration Request Form
DME Authorization Request Form
Drug Prior Authorization Requests Supplied by the Physician/Facility
Requests for prior authorization (with supporting clinical information and documentation) should be sent to ʻOhana 14 days prior to the date the requested services will be performed.
Telemedicine Authorization Request Form
Behavioral Health Service Request Form
Refund Check Information Sheet* (RCIS)
Drug Prior Authorization Requests Supplied by the Physician/Facility
Request for Review of Medicare Prescription Drug Denial
This policy provides a list of drugs that require step therapy. Step therapy is when we require the trial of a preferred therapeutic alternative prior to coverage of a non-preferred drug for a specific indication.
This policy provides a list of drugs that require step therapy effective January 1, 2024. Step therapy is when we require the trial of a preferred therapeutic alternative prior to coverage of a non-preferred drug for a specific indication.
