The WellCare Group of Companies has recently reviewed our internal processes for potential enhancements based on your feedback, and as such, we are excited to announce some important outpatient prior authorization requirement changes for our Medicare product. We are reducing the amount of services/procedures requiring prior authorization. In addition, we are reviewing other lines of business and plan to make similar changes in the near future to further simplify and streamline our authorization rules and requirements. These updates are designed to help ease your day-to-day interactions with WellCare while allowing us to continue to exercise responsible stewardship over the government funded health care programs we administer.
For dates of service on or after Aug. 5th, 2017, we are standardizing authorization requirements across ALL outpatient places of service for our Medicare services.
For dates of service on or after Aug. 5th, 2017, we are standardizing authorization requirements across ALL outpatient places of service for our Medicare services.
- We have reduced the CPT codes that require an outpatient authorization requirements by over 60%
- Our outpatient authorization requirements will be applied across all services rendered in all outpatient settings.
- Other UM thresholds and rules such as high dollar DME claims will continue although we have increased some of the thresholds.
For questions regarding this notice, please contact Provider Services at 1-855-538-0454 between 8 a.m. and 6:30 p.m. When prompted say Authorizations or press 2.
Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.
Sincerely,
WellCare Health Plans, Inc.