WellCare ᏕᎬᏗᏍᎪ ᎤᏂᎦᎾᏍᏓ. ᎾᏍᎩ ᏫᎬᎵᏱᎵᏒᎢ ᎾᎢ ᎬᏙᏗ ᎣᎦᏤᎵ ᎤᏙᏢᏒ, ᏂᎯ ᎣᏏ ᏣᏰᎸᏅᎢ ᎾᎢ ᎣᎦᏤᎵ ᎤᏕᎵᏓ ᏗᎳᏏᏙᏗ ᎠᎴ ᏗᏓᏕᏤᎸ ᎬᏙᏗ.
Access key forms for authorizations, claims, pharmacy and more.
Use this form to appoint an individual to act as a representative.
Use this form to file an appeal or dispute based on a claim outcome.
Wellcare Provider Payment Dispute Request Form
Non-Par Provider Payment Dispute Request Form
Wellcare Participating Provider Reconsideration Request Form
Non-Par Non Par Reconsideration Request Form
DME Authorization Request Form
Drug Prior Authorization Requests Supplied by the Physician/Facility
Requests for prior authorization (with supporting clinical information and documentation) should be sent to ʻOhana 14 days prior to the date the requested services will be performed.
Refund Check Information Sheet* (RCIS)
We strive to cover the most common drugs across all conditions. Below are some common drugs not covered by the plan, along with alternative drugs that are covered. If your patient is currently on a drug that is not covered, please see if the formulary alternatives listed below would work for your patient.
Drug Prior Authorization Requests Supplied by the Physician/Facility
MCPB.ST.00: This policy provides a list of drugs that require step therapy effective January 1, 2025
