Dear Provider,
Wellcare has partnered with Evolent (formerly National Imaging Associates, Inc.) to implement new Musculoskeletal Care ‘MSK’ Management and Interventional Pain Management ‘IPM” Programs. This program is intended to help providers easily and effectively deliver quality patient care. Learn more about the MSK and IPM Services (PDF) that are part of the Evolent program.
Effective April 1, 2024, musculoskeletal surgeries and interventional pain management services will require prior authorization through Evolent. Prior authorization will be required for these services when rendered in the physician office, ambulatory surgical centers, outpatient facilities and inpatient (planned professional services only - MSK services only).
Wellcare authorizations issued before April 1, 2024, will be effective until the authorization end date. These management programs apply to your Wellcare Medicare members of all ages.
Below is a list of MSK and IPM codes that will require an authorization on April 1, 2024 – As this list may change, the most updated list can be found at www.RadMD.com.
Prior authorization requests for can be submitted to Evolent:
- Online www.RadMD.com
- Via telephone at 1-800-424-5388. Staff is available Monday-Friday from 8:00 a.m. to 8:00 p.m. EST.
Evolent uses clinical criteria based on nationally recognized guidelines to promote evidence-based practices. When using the Evolent web portal, you will be able to:
- Obtain real-time approvals when selecting evidence-based treatment care pathways
- Determine the clinical documentation required for medical necessity review
- View all submitted requests
Wellcare and Evolent welcome providers to attend one of their upcoming provider education webinars on the Evolent MSK Management Program prior authorization process. Learn more about the webinars (PDF) and to how to register.
Wellcare is proud to be your healthcare partner. If you frequently request MSK or IPM services or are new to this process, Evolent representatives will contact you soon to schedule an introductory meeting and training.
If you have questions about these programs, please email RadMDsupport@evolent.com or call 1-800-327-0641.
We look forward to working with you.
