Effective January 1, 2023: Medicare Prior Authorization Requirements

Date: 11/23/22

Wellcare By Allwell (HMO and HMO DSNP) requires prior authorization as a condition of payment for many services. This notice contains information regarding these prior authorization requirements and is applicable to all Medicare products offered by Wellcare.

Wellcare is committed to delivering cost effective quality care to members. This effort requires us to ensure that members receive only treatment that is medically necessary according to current standards of practice.

Effective January 1, 2023, prior authorization will be required for certain services. To access a list of services that will require prior authorization, please review the Medicare Prior Authorization List – Effective January 1, 2023 (PDF). The link to this update is available on  Superior’s Prior Authorization Requirements webpage.

Additionally, Wellcare’s Medicare Part B Drugs List has also been updated. Please review this listing for the latest Part B drugs that require prior authorization, effective January 1, 2023. To find a list of Medicare Part B List of Drugs Requiring Prior Authorization, please visit the Medicare Advantage Pharmacy Resources section of Superior’s Pharmacy webpage.

Please note: Prior authorization is a process initiated by the ordering physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria. It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. Prior authorization is subject to covered benefit review and is not a guarantee of payment.

For questions, please contact Provider Services at 1-877-391-5921.