WellCare of Kentucky
Welcome to the WellCare of Kentucky Medicare and Medicaid 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, Andrew Dietz.
- WellCare of KY Medicaid no longer requires an authorization for requests with POS 22 for DOS 8/11/2021 and beyond.
- Kentucky Department for Medicaid Services recently announced that services performed in an On Campus-Outpatient Hospital setting, POS 22, do not require a prior authorization.
Update on Physical Medicine
Due to unforeseen operational challenges, these programs have been delayed until further notice. eviCore will continue to manage all rehabilitative and habilitative physical medicine requests for the time being. Therefore, please continue to submit prior authorization to eviCore until further notice. Please be on the lookout for further communication on this topic in the future.
Advanced Imaging Program
- Provider Education PowerPoint
- Prior Authorization Checklist
- Frequently Asked Questions
- Rendering Provider Quick Reference Guide
- Ordering Provider Quick Reference Guide
- Cardiac Solutions Frequently Asked Questions
- Cardiac Checklist
- Cardiac Solutions Tip Sheet
- Utilization Review Matrix-2022 +0722T & +0724T will be effective 10/01/2022
- Recording of Provider Education Training
- Peer-to-Peer Process
Interventional Pain Management (IPM) Program
- IPM Utilization Review Matrix-2022
- IPM Quick Reference Guide
- IPM Checklist
- IPM Frequently Asked Questions
- IPM Provider Training
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
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
- 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).