Wellcare by Allwell Pharmacy Updates Effective May 1, 2019
Date: 05/01/19
Provider Partners,
Wellcare by Allwell requires prior authorization as a condition of payment for many services. This Notice contains information about changes to the Medicare Part B drugs we will require prior authorization for effective May 1, 2019.
As part of our effort to provide our members with cost-effective quality healthcare, we work to be sure that our members only receive treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the ordering physician in which we verify the medical necessity of a treatment in advance using independent, objective medical criteria.
It is the ordering provider’s responsibility to determine which specific codes require prior authorization. Effective May 1, 2019, prior authorization requirements will be added to the Part B Drugs listed below. Please refer to the information below for guidance regarding how to obtain prior authorizations from Wellcare by Allwell.
How do I determine if a specific treatment requires prior authorization?
- You can determine which codes require prior authorization by visiting our website at Wellcare.ARHealthWellness.com and clicking on the Pre-Auth Check tab. Just enter the CPT code and you will be advised whether the service requires prior authorization.
How do I request a prior authorization for these services?
- You can submit prior authorization requests using our Secure Provider Portal at Wellcare.ARHealthWellness.com. If your request is approved, you will receive verification through the Secure Web Portal. If you don’t have an account set up on the Secure Provider Portal yet, signing up is easy and only takes a few minutes.
- You may submit the Prior Authorization request by faxing an authorization to 1-833-526-7172. The fax authorization form can be found on our website at the Wellcare by Allwell Coverage Determinations and Redeterminations for Drugs page. The form can be downloaded by clicking the PDF link in the chart hosted on this page.
- You may call our Medical Management department at 1-855-565-9518 (TDD/TTY: 711).
What information will I be required to submit in connection with the prior authorization request?
- Pertinent clinical information related to the request
- CPT code
- Diagnosis Code
- Rendering facility’s name, Tax ID number, and NPI number
If you have any questions regarding this information, you may contact Provider Services at 1-855-656-9518 or contact your dedicated Provider Relations Specialist.