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Notice Regarding Authorization Requirements

We would like to take this opportunity to inform you that effective March 1, 2020, there will be an increased focus on ensuring that our providers follow our existing pre-service authorization and notification requirements as stated within your provider manual.  

Prior authorization is the process of obtaining approval >in advance of rendering a service. Prior authorization allows for efficient use of covered healthcare services. It also ensures that members receive the most appropriate level of care at the most appropriate setting.

WellCare would like to remind our providers that prior authorization is required for elective or non-emergency services as designated by WellCare. Our policies on requests for authorizations are contained within in your provider manual.

Inpatient Admissions: WellCare requires notification by the next business day when a member is admitted to a facility. This includes all admissions, including admissions to behavioral health facilities. WellCare needs this notification to obtain clinical information to perform case management and ensure coordination of services. If you fail to notify WellCare of admissions or observation stays, the claim may be denied.

Please always check eligibility and confirm benefits before rendering services to members. If you have any questions about this notice, please contact your Provider Relations representative or Provider Services at 1-855-538-0454.

Thank you for your continued participation and cooperation. We look forward to working with you to deliver the highest quality of care to your patients, and our members.

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Last Updated On: 5/4/2020