Wellcare by Allwell (Medicare)
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 New Century Health
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
Are services being performed in the Emergency Department or Urgent Care Center, or are the services for dialysis or hospice?
| Types of Services | YES | NO |
|---|---|---|
| IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY? | ||
| ARE ANESTHESIA SERVICES BEING RENDERED FOR PAIN MANAGEMENT, DENTAL SURGERY, OR SERVICES IN THE OFFICE RENDERD BY A NON-PARTICIPATING PROVIDER? | ||
| IS THE MEMBER RECEIVING GENDER REASSIGMENT SERVICES? | ||
| IS THIS AN HMO OUT OF NETWORK SERVICE REQUEST? | ||
| ARE THE SERVICES BEING PERFORMED OR ORDERED BY A NON-PARTICIPATING PROVIDER (PROFESSIONALS/FACILITIES)? |