Wellcare Medicare
Welcome to the Wellcare Medicare page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc.) is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.
If you have any questions about our programs, please contact your dedicated Evolent Provider Relations Manager:
- Alabama (4/1/21): ProviderRelationsSupport@evolent.com
- Arizona (3/1/21): Lori Fink
- Arkansas (4/1/21): ProviderRelationsSupport@evolent.com
- California (1/1/22): Debbie Patterson
- Connecticut (4/1/21): Charmaine Everett
- Delaware: (1/1/24) Charmaine Everett
- Florida (4/1/21): Andrew Dietz
- Georgia (4/1/21): Debbie Patterson
- Illinois (4/1/21): ProviderRelationsSupport@evolent.com
- Indiana (4/1/21): Andrew Dietz
- Kentucky (4/1/21): Andrew Dietz
- Louisiana (4/1/21): Priscilla Singleton
- Michigan (4/1/21): Lori Fink
- Maine (4/1/21): Mara Grimm
- Massachusetts (1/1/22): Mara Grimm
- Michigan (4/1/21): Lori Fink
- Missouri (4/1/21): Debbie Patterson
- Mississippi (4/1/21): Priscilla Singleton
- Nebraska (1/1/22): Andrew Dietz
- New Hampshire (4/1/21): Seth Cohen
- New Jersey (4/1/21): Seth Cohen
- New York (4/1/21): Seth Cohen
- North Carolina (7/1/21): Priscilla Singleton
- Ohio (4/1/21): Mara Grimm
- Oklahoma (1/1/22): Andrew Dietz
- Rhode Island (1/1/21): Mara Grimm
- South Carolina (4/1/21): Priscilla Singleton
- Tennessee (4/1/21): Debbie Patterson
- Texas (4/1/21): ProviderRelationsSupport@evolent.com
- Vermont (1/1/21): Mara Grimm
- Washington (4/1/21): Debbie Patterson
Advanced Imaging Program
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Quick Reference Guide for Ordering Providers
- Quick Reference Guide for Rendering Providers
- Utilization Review Matrix (AL, AR, AZ, CT, FL, GA, IL, IN, KY, MA, ME, MI, MO, MS, NC, NJ, NY, OH, RI, TN, TX, VT, WA)
- Utilization Review Matrix (LA, NH)
For access to State-specific Advanced Imaging Program documents, click below:
For access to our Advanced Imaging tip sheets/checklists, click here.
Cardiac Program
For access to State-specific Cardiac Program documents, click below:
For access to our Cardiac tip sheets/checklists, click here.
Interventional Pain Management Program
- Frequently Asked Questions
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix (AL, AR, CT, IL, LA, MA, ME, MO, MS, NC, NH, RI, SC, TN, VT, WA)
- Utilization Review Matrix (GA, OH, NJ, NT, TX)
For access to State-specific Interventional Pain Management Program documents, click below:
- Alabama
- Connecticut
- Georgia: Effective 7/1/2023
- Louisiana
- Mississippi
- New Hampshire
- New Jersey
- South Carolina: Effective 2/1/24
For access to our Interventional Pain Management tip sheets/checklists, click here.
Musculoskeletal Program
- Utilization Review Matrix (MSK - Hip, Knee and Shoulder - Medicare)
- Utilization Review Matrix (MSK - Spine Surgery - Medicare)
- Utilization Review Matrix (MSK - Hip, Knee and Shoulder - Medicare) (FL, GA, NJ, NY, OH, TX)
- Utilization Review Matrix (MSK - Spine Surgery - Medicare) (FL, GA, NJ, NY, OH, TX)
For access to State-specific Musculoskeletal Program documents, click below:
- Alabama: Effective 3/1/24
- Connecticut: Effective 3/1/24
- Georgia: Effective 1/1/24
- Louisiana: Effective 1/1/24
- Maine: Effective 4/1/24
- Massachusetts: Effective 4/1/24
- Michigan: Effective 4/1/24
- Mississippi: Effective 3/1/24
- Missouri: Effective 3/1/24
- New Hampshire: Effective 2/1/24
- New Jersey: Effective 7/1/23
- Rhode Island: Effective 4/1/24
- South Carolina: Effective 2/1/24
- Tennessee: Effective 2/1/24
- Vermont: Effective 4/1/24
- Washington: Effective 2/1/24
For access to our Musculoskeletal tip sheets/checklists, click here.
Physical Medicine Program
For access to State-specific Physical Medicine Program documents, click below:
Update for Wellcare Connecticut, New York and Tennessee:
- Home Health Providers submitting claims utilization G-Codes for all home therapy services are excluded from the Physical Medicine Program
Update for Wellcare Kentucky, Louisiana and Connecticut:
- Effective 07/01/2022 Inpatient and Outpatient Therapy performed in a Home Health Setting is excluded from the Physical Medicine Program
For access to our Physical Medicine tip sheets/checklists, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
Low Dose Chest CT History Form
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.