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Prior authorization is not required for standard outpatient services. However, other services may require prior authorization, including those offered by non-participating providers. Services requiring authorization include:

  • Residential treatment
  • Acute inpatient hospitalization
  • Partial hospitalization program
  • Intensive outpatient program
  • ECT treatment
  • Assertive community treatment services
  • Psychological testing

Please see our Quick Reference Guide for more information about authorization requirements.

Submit an Authorization

  • Urgent authorizations: Call 1-800-424-5412
  • Inpatient authorization: Fax request to 1-888-361-6574
  • Outpatient authorization: Fax request to 1-888-871-0590

Authorization Requirements

Billing Guidelines

Other Guidelines

WellCare uses nationally accepted guidelines for assessing level-of-care criteria:

  • InterQual™ for behavioral health.
  • American Society for Addiction Medicine (ASAM) for substance abuse.

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Last Updated On: 5/3/2021
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