WellCare of Kentucky
Welcome to the WellCare of Kentucky Medicare and Medicaid 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: Meghan Murphy
Alert
- 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 COVID-19
Update on Physical Medicine & Interventional Pain Management Program
Due to unforeseen operational challenges, these programs have been delayed until further notice. eviCore will continue to manage all pain management and 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.
WellCare of Kentucky - Documents
- WellCare of KY Provider Education PowerPoint
- WellCare of KY Prior Authorization Checklist
- WellCare of KY Frequently Asked Questions
- WellCare of KY Rendering Provider Quick Reference Guide
- WellCare of KY Ordering Provider Quick Reference Guide
- WellCare of KY Cardiac Solutions Frequently Asked Questions
- WellCare of KY Cardiac Checklist
- WellCare of KY Cardiac Solutions Tip Sheet
- WellCare of KY Utilization Review Matrix-2021
- WellCare of KY Recording of Provider Education Training
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.