April 25, 2025
Wellcare requires prior authorization as a condition of payment for many services. This notice contains information regarding these prior authorization requirements and is applicable to all Medicare products offered by Wellcare.
Wellcare is committed to delivering cost effective quality care to members. This effort requires us to ensure that members receive only treatment that is medically necessary according to current standards of practice.
Effective July 1, 2025, changes to prior authorization requirements will be made for certain services on the Medicare Prior Authorization List – Effective July 1, 2025 (PDF), and will also be available on the Medicare Prior Authorization Tool webpage.
Please note: 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/prescribing provider’s responsibility to determine which specific codes require prior authorization. Prior authorization is subject to covered benefit review and is not a guarantee of payment. Non-par providers and facilities require authorization for all HMO services except where indicated.
