Dagiti Tagaipaay

Utilization Management Vendor Updates

August 30, 2021

Dear Provider,
Thank you for your valued partnership. We want to inform you of several upcoming changes that will affect the Michigan Wellcare Medicare plans. These changes will be effective on November 1, 2021.

Utilization Management Vendor Updates

Terming Vendors: Effective November 1, 2021, H3 Management Services and Innovista Health Solutions will no longer manage authorizations for Michigan and Ohio Wellcare Medicare plans.

Utilization Management Process Updates

The following process changes will be in effect beginning November 1, 2021:

• Peer to Peer (P2P)
• The P2P number is changing to 1-866-329-7651
• Timeframes will be as follows:
• Prior Authorization: Request for P2P must be made within 24 hours of receiving of intent to deny
• Concurrent Review: The provider has 7 days to request a P2P review from the date the denial letter goes out. Denial may be overturned pending the information presented in the P2P if the member remains inpatient at the time of the P2P

Request Submission Options

There will be updates to the request submission process as a result of the changes mentioned above. The grid below outlines submission options by service type, and includes notes of the changes effective November 1, 2021.

For questions about this notice, please refer to the Quick Reference Guide that will be available on November 1, 2021 at www.wellcare.com. If you need further assistance, please call your Provider Network Development Representative or Provider Services at 1-855-538-0454.