Use our Provider Portal @ Provider.Wellcare.com. Outpatient Authorization Request Form. *Indicates a required field. Requirements: Clinical information and ...

CHECK ONE OF THE FOLLOWING: □ Ambulatory Surgery. □ Dialysis. □ Lab Services. □ Office visit and/or Procedures. □ Outpatient Hospital Service □ Radiation ...

Use our Provider Portal @ provider.wellcare.com. Outpatient Authorization Request Form. *Indicates a required field. Requirements: Clinical information and ...

OUTPATIENT MEDICAID. AUTHORIZATION FORM. Complete and Fax to: 1-800-268-8847. Request for additional units. Existing Authorization. Units. Standard requests ...

OUTPATIENT MEDICARE. AUTHORIZATION FORM. PENNSYLVANIA. All Part B Drug Requests: Fax 844-941-1330. Expedited Requests: Call 1-855-766-1456. Standard Requests ...

A repository of Medicare forms and documents for WellCare providers, covering topics such as authorizations, claims and behavioral health.

Authorization Forms. Medicare Outpatient Authorization (PDF) - last updated Dec 16, 2022; Medicare Inpatient Authorization (PDF) - last updated Dec 16, 2022 ...

For Standard requests, complete this form and FAX to the appropriate department. Determination made as expeditiously as the enrollee's health condition requires ...

Access key forms for authorizations, claims, pharmacy and more. Ancillary Contract Packet If you provide services such as home health, Personal care services, ...

Inpatient Authorization Form (PDF) · Outpatient Authorization Form (PDF) · Supplemental Outpatient Authorization Form (PDF) · Well-Being Survey (PDF) · Member ...