WellCare of North Carolina

Welcome to the WellCare of North Carolina page.  The Medicaid (WellCare of North Carolina), Medicare (Wellcare of North Carolina) and Exchange (WellCare of North Carolina by Celtic Insurance Company) documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent 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 Engagement Manager:

• Brandi Patterson (Advanced Imaging/Cardiology)
• Karla Lowery (Interventional Pain Management/Musculoskeletal/Physical Medicine)

MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process. 

Any services requested that are listed on the IFSP form will be redirected back to Medicaid Direct for children less than 3 years of age. Evolent will not process these requests.  

Peer-to-Peer Process  

For access to our peer-to-peer process, click here.

Conservative Treatment Forms  

For access to our conservative treatment forms, click here.

Low Dose Chest CT History Form  

Low Dose Chest CT History Form