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Effective April 8, 2026: Clinical Policies

Date: 01/12/26

Wellcare By Allwell has approved policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on April 8, 2026, at 12:00AM.

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Medical Necessity Criteria

(MC.CP.CPC.05)

Wellcare By Allwell (Medicare)

New Policy Overview:

  • Policy developed; adapted from CP.CPC.05 Medical Necessity Criteria
  • Policy includes:
    • Description: provides medical necessity criteria and related definitions
    • Policy/Criteria: guidelines to make medical necessity decisions on a case-by-case basis, based on the information provided on the member/enrollee’s health status.
    • Background
    • References

To review all policies, please visit Medicare Prior Authorization Clinical Policies webpage.

Prior to updates, the policies were approved for use by Medicare Quality Committee.

For questions or additional information, please contact Wellcare By Allwell Provider Services at HMO: 1-800-977-7522 DSNP: 1-877-935-8023.