WellCare Medicare
Welcome to the WellCare Medicare page. Here you can download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and information designed to assist you in using the RadMD Website to obtain and check authorizations.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager:
- Alabama: Priscilla Singleton
- Arkansas: Leta Genasci
- Connecticut: Charmaine Everett
- Illinois: Leta Genasci
- Indiana: April Sabino
- Louisiana: Gina Braswell
- Michigan: Meghan Murphy
- Maine: Meghan Murphy
- Massachusetts: Meghan Murphy
- Missouri: Gina Braswell
- Mississippi: Priscilla Singleton
- Nebraska: Andrew Dietz
- New Hampshire: Meghan Murphy
- New York: Seth Cohen
- North Carolina: Priscilla Singleton
- Ohio: Meghan Murphy
- Oklahoma: April Sabino
- Tennessee: Priscilla Singleton
- Texas: Gina Braswell
- Washington: Debbie Patterson
WellCare Documents
- Provider Training (For 1/1/2022 Go Live)
- Quick Reference Guide for Ordering Providers (For 1/1/2022 Go Live)
- Quick Reference Guide for Rendering Providers (For 1/1/2022 Go Live)
- Frequently Asked Questions (For 1/1/2022 Go Live)
- Utilization Review Matrix-2022
- Prior Authorization Checklist
- Cardiac Checklist
- Cardiac Frequenty Asked Questions (For 1/1/2022 Go Live)
- Cardiac Tip Sheet - Myocardial Perfusion Imaging vs. Stress Echo
- WellCare Medicare RBM Recording of Provider Training (For 1/1/2022 Go Live)
- Peer-to-Peer Process
Physical Medicine Documents
- Physical Medicine Tip Sheet and Checklist
- Physical Medicine Provider Training (For 1/1/2022 Go Live)
- Physical Medicine Quick Refence Guide (For 1/1/2022 Go Live)
- Physical Medicine Frequently Asked Questions (For 1/1/2022 Go Live)
- Physical Medicine Recording of Provider Training (For 1/1/2022 Go Live)
IPM Documents
- IPM Checklist
- IPM Conservative Treatment Form
- IPM Utilization Review Matrix
- IPM Provider Training (For 1/1/2022 Go Live)
- IPM Frequently Asked Questions (For 1/1/2022 Go Live)
- IPM Quick Reference Guide (For 1/1/2022 Go Live)
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Click the link below to see information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
- Click here to view NIA’s Physical Medicine guidelines
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).