Medicare Prior Authorization
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 upon eligibility covered benefits, Provider contracts and correct coding and billing practices. For specific details, please refer to the Wellcare By Allwell (Medicare) Provider Manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Important Reminder: Effective July 1, 2025, tango and WellSky will be delegated for Skilled Home Health and Post-Acute Facility management services for Wellcare and Wellcare By Allwell members. Please direct all PAC authorizations to WellSky and all Home Health authorizations to tango starting July 1, 2025. To learn more please visit the tango and WellSky Provider Resource Center.
The following services need to be verified by Evolent.
Complex imaging, MRA, MRI, PET, and CT scan
Musculoskeletal services
Pain Management
Therapy - PT/OT/ST
Ear, Nose and Throat (ENT) Surgeries and Cardiac Surgeries Need to be Verified by TurningPoint.
All Out of Network requests require prior authorization except emergency care, out-of-area urgent care or out-of-area dialysis.
Are services being performed in the emergency department, urgent care center, for dialysis, hospice or a psychiatric hospitalization?
| Types of Services | YES | NO |
|---|---|---|
| Is the member being admitted to an inpatient facility? | ||
| Are anesthesia services being requested for pain management, dental surgery or services in the office rendered by a non-participating provider? | ||
| Is this an HMO Out of Network service request? |
To submit a prior authorization Login Here.
To access prior authorization lists, please visit Superior’s Prior Authorization Requirements webpage.
To access Superior clinical and payment policies, visit Clinical & Payment Polices.