Wellcare (Medicare)
DISCLAIMER: All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
The following services need to be verified by Evolent.
Complex imaging, MRA, MRI, PET, and CT scan
Musculoskeletal services
Oncology/supportive drugs for members age 18 and older need to be verified by Evolent.
Interventional Cardiology services for members 21 years and older need to be verified by Evolent.
Tango and Wellsky are delegated for Skilled Home Health and Post-Acute Facility (SNF, IRF, LTACH) management services for Wellcare by Allwell HMO members. Please direct all PAC facility authorizationsto WellSky and all Home Health authorizations to tango. Learn more here.
View our Medicare Prior Auth Change List effective October 15, 2025 (PDF).
Except Emergency Care, Urgent Care, or Acute Medical Inpatient Services.
Non-participating providers must submit Prior Authorization for all services.
For non-participating providers, Join Our Network
Prior Authorization at a Glance
Prior Authorization is NOT Required
The following services do NOT require prior authorization:
- Services rendered in an emergency room or urgent care center
- Services rendered by a public health or welfare agency
- Family planning services billed with a contraceptive management diagnosis
Prior Authorization IS Required
The following services REQUIRE prior authorization:
- Services rendered by an out out-of-network provider, with the exception of emergency and urgent care services
- Admission of a member to an inpatient facility
- Hospice services
- Anesthesia services for pain management or dental procedures.
- Services rendered at home, other than DME, orthotics, prosthetics, supplies and therapeutic injections
- Services rendered by a chiropractor
Prior Authorization Check
To submit a prior authorization Login Here