Wellcare: Prior Authorization changes effective through 03/01/2022

Date: 02/02/22

Wellcare (Medicare):

02/02/2022 Update: Prior authorization changes have now been extended for Medicare through 03/01/2022.

 

To support the Wellcare membership and Wellcare Provider Network, the following changes will be effective through January 31, 2022:

Inpatient Admissions:  Wellcare will allow notification of admission up to 5 days post admission date and complete medical necessity reviews when notification is received.

Post-Acute Accommodations for rehab hospitals and Long Term Acute Care hospitals (LTACH):

Wellcare will relax our requirements related to facility transfers including:

a. Wellcare will not require discharging acute care facilities to obtain prior authorization for patient transfers to participating post-acute facilities. 

b. Wellcare will not require sending facilities to provide notification of transfer to participating providers. 

c. However, Wellcare will require receiving facilities to notify the health plan of patient admission.  Wellcare will accept notification up to five days post-transfer.

d. Wellcare will continue to conduct medical necessity review

e. Because Wellcare will not have visibility prior to transfer, Wellcare request that hospitals utilize our in network post-acute facilities

Skilled Nursing Facilities: Wellcare will allow post admission notification and authorize up to a 7 day stay before medical necessity continued stay review.

If you have any questions, please contact Provider Relations at 1-844-385-2192 (TTY 711).