For Providers

• 2026 Wellcare Provider Manual (PDF)

• Quick Reference Guide (PDF)
• Appeals/Reconsiderations (Medical) and Grievances Guide (PDF)
• Claims, Disputes & Recovery/CCU Guide (PDF)
• Pharmacy Guide (PDF)
• Prior Authorization Guide (PDF)

In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.

Reports:

• Wellcare CMS Final Rule 0057-F Prior Authorization Requirements: H3499 & H6348 (PDF)
• Wellcare Prior Authorization Metrics Summary: H3499 (PDF)
• Wellcare Prior Authorization Metrics Summary: H6348 (PDF)

The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.

• 2026 Alternative Covered Drugs (PDF)
• Step Therapy Part B Provider updated (PDF)

• Electronic Funds Transfer (EFT) Payspan (PDF)

• Managed Health Services Ambetter and Wellcare Cardiac Surgical Quality and Safety Management Program Expansion in Partnership with TurningPoint (PDF)
• Medicare Prior Authorization Change Summary (PDF) Effective 7/1/2025
• Inpatient Medicare Authorization Form (PDF)
• Outpatient Medicare Authorization Form (PDF)

• Wellcare Provider Patient Experience Survey (PDF)
• Health Outcomes Survey (HOS) (PDF)
• 2024 HEDIS Quick Reference Guide (PDF)
• CAHPS Resource Guide (PDF)
• Wellcare Provider-Patient Experience (PDF)
• Tips for Improving Patient Experience & Quality of Life (PDF)

• Model of Care Training (PDF)