WellCare Medicare
Welcome to the WellCare Medicare Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager:
- Alabama (4/1/21): Priscilla Singleton
- Arizona (3/1/21): April Sabino
- Arkansas (4/1/21): Leta Genasci
- California (1/1/22): April Sabino
- Connecticut (4/1/21): Charmaine Everett
- Florida (4/1/21): Andrew Dietz
- Georgia (4/1/21): Debbie Patterson
- Illinois (4/1/21): Leta Genasci
- Indiana (4/1/21): April Sabino
- Kentucky (4/1/21): Andrew Dietz
- Louisiana (4/1/21): Gina Braswell
- Michigan (4/1/21): Meghan Murphy
- Maine (4/1/21): Meghan Murphy
- Massachusetts (1/1/22): Meghan Murphy
- Michigan (4/1/21): Meghan Murphy
- Missouri (4/1/21): Gina Braswell
- Mississippi (4/1/21): Priscilla Singleton
- Nebraska (1/1/22): Andrew Dietz
- New Hampshire (4/1/21): April Sabino
- 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): Meghan Murphy
- Oklahoma (1/1/22): April Sabino
- Rhode Island (1/1/21): Meghan Murphy
- South Carolina (4/1/21): Priscilla Singleton
- Tennessee (4/1/21): Priscilla Singleton
- Texas (4/1/21): Gina Braswell
- Vermont (1/1/21): Meghan Murphy
- Washington (4/1/21): Debbie Patterson
Advanced Imaging Program
- Provider Training
- Quick Reference Guide for Ordering Providers
- Quick Reference Guide for Rendering Providers
- Frequently Asked Questions
- Utilization Review Matrix-2022 +0722T & +0724T will be effective 10/01/2022
- Prior Authorization Checklist
- Cardiac Checklist
- Cardiac Frequently Asked Questions
- Cardiac Tip Sheet - Myocardial Perfusion Imaging vs. Stress Echo
- WellCare Medicare RBM Recording of Provider Training
- Peer-to-Peer Process
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
- Physical Medicine Tip Sheet and Checklist
- Physical Medicine Provider Training
- Physical Medicine Quick Refence Guide
- Physical Medicine Frequently Asked Questions
- Physical Medicine Recording of Provider Training
IPM Program
- IPM Checklist
- IPM Conservative Treatment Form
- IPM Utilization Review Matrix-2022
- IPM Provider Training
- IPM Frequently Asked Questions
- IPM Quick Reference Guide
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD Documents
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
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.
2013 Jimmo vs Sebelius Settlement Agreement
Click here for 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).