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.
