February 28, 2024
Wellcare has partnered with Evolent (formerly National Imaging Associates, Inc.) to implement new Musculoskeletal Care ‘MSK’ Management and Interventional Pain Management ‘IPM” Programs. This program is intended to help providers easily and effectively deliver quality patient care.
Effective April 1, 2024, musculoskeletal surgeries and interventional pain management services will require prior authorization through Evolent. Prior authorization will be required for these services when rendered in the physician office, ambulatory surgical centers, outpatient facilities and inpatient (planned professional services only - MSK services only).
Wellcare authorizations issued before April 1, 2024, will be effective until the authorization end date. These management programs apply to your Wellcare Medicare members of all ages.
Below is a list of MSK and IPM codes that will require an authorization on April 1, 2024 – As this list may change, the most updated list can be found at www.RadMD.com.
Prior authorization requests for can be submitted to Evolent:
- Online www.RadMD.com
- Via telephone at 1-800-424-5388.
- Staff is available Monday-Friday from 8:00 a.m. to 8:00 p.m. EST.
Evolent uses clinical criteria based on nationally recognized guidelines to promote evidence-based practices.
When using the Evolent web portal, you will be able to:
- Obtain real-time approvals when selecting evidence-based treatment care pathways
- Determine the clinical documentation required for medical necessity review
- View all submitted requests
Wellcare is proud to be your healthcare partner. If you frequently request MSK or IPM services or are new to this process, Evolent representatives will contact you soon to schedule an introductory meeting and training. If you have questions about these programs, please email RadMDsupport@evolent.com or call 1-800-327-0641.
The Evolent program will apply to all specialties for the following MSK and IPM services (PDF).
