Welcome to the Submitting Medical Authorizations training video!

To create a new authorization request, users should access Care Management and select Create New Authorization.

Users are then prompted to search for a member. Search options include WellCare Member ID, Medicare ID, Medicaid ID, or patient name and date of birth.

Once the member is located and selected, click the Select Member button.

The user is then routed to the appropriate authorization request form.

Please note that lines of business that haven’t yet migrated to WellCare’s new medical management platform will see the previous legacy version of the authorization request form in a new window. This is temporary and will only be in place until all remaining lines of business are on our new medical management platform.

In cases in which a user is directed to the legacy authorization request form, the experience will be identical to the previous portal. Users should complete required fields, upload any supporting clinical documentation and submit the request.

All other users will see an authorization request form that is aligned with the look and feel of the new portal. We’ll review the new request form later in this training.

One way for users to save time when requesting an authorization is to start with the My Patients search. When searching for a member via My Patients, users can initiate a number of transactions, including an authorization request. Taking this route ensures that all of the member’s information is pre-populated on the authorization request screen.

If the user is affiliated with a single provider ID, the provider information will also prepopulate. If the user is associated with multiple provider IDs, he or she will have to search and select a provider using the Choose a Provider tool.

Next, users choose whether the member has already been admitted by selecting Yes or No.

The response to this question determines whether the request is a prior authorization or an admission authorization. Notice that the set of fields and questions changes based on selecting Yes or No.

Prior Authorizations

Selecting No indicates that this is a prior authorization.

First, select the servicing provider type. If the servicing provider is the same as the requesting provider, select the checkbox to the left of the provider ID field.

Additional servicing providers can be added by selecting the + button.

An advanced search option is also available if needed to locate servicing providers.

Next, complete the Authorization Information section, which includes diagnosis information and CPT codes.

Note that as a user begins to type in the diagnosis and CPT code fields, a list of options will pre-populate from which the user can select the appropriate code.

Additional diagnosis and CPT codes can be added using the + buttons and deleted using the trash can icons.

At this point, users must select the Is Auth Required? button. The screen will display whether or not authorization is required for any of the selected procedures. If authorization is not required, the user can stop here and does not need to proceed with the request. If authorization is required, the user should proceed with completing the form.

The system will also indicate whether the member is eligible or if the member’s benefits have been exhausted.

Next, complete the Requestor Information section, and indicate whether the authorization is urgent.

Finally, upload supporting clinical documentation by clicking the Select Files button. Please note that at least one supporting clinical attachment is required for submission.

If a user needs to delete an attachment for some reason, they can do so using the trash can icon.

All required fields are denoted by an asterisk. The system will alert users to any missing required fields prior to submission.

Also note that each section of the claim form can be collapsed and expanded as needed if users want to hide sections they’ve already completed.

Once all required fields are completed and supporting clinical documentation attached, users should select the Review Authorization button. This takes users to a screen that allows them to review everything entered. Please note the authorization has not been submitted at this point.

The user should review all their information. If they need to make changes, select the Edit Authorization button. Otherwise, select the Submit Authorization button.

After submitting, the user is taken to a confirmation screen on which an authorization reference number appears. If the authorization is auto-approved, an authorization number will appear on this screen.

Admission Authorizations

Now, let’s review how to request an admission authorization.

Selecting Yes indicates that this is an admission authorization.

First, select the servicing provider type. If the servicing provider is the same as the requesting provider, select the checkbox to the left of the provider ID field.

Additional servicing providers can be added by selecting the + button.

An advanced search option is also available if needed to locate servicing providers.

Next, complete the Authorization Information section, including diagnosis information and procedure information.

As users begin to type in the diagnosis and CPT code fields, a list of options will pre-populate from which the user can select the appropriate code.

Additional diagnosis and CPT codes can be added using the + buttons and deleted using the trash can icons.

Next, complete the Requestor Information section and indicate whether the authorization is urgent.

Next, upload supporting clinical documentation by clicking the Select Files button. Please note that at least one supporting clinical attachment is required for submission.

If a user needs to delete an attachment for some reason, they can do so using the trash can icon.

Note that each section of the authorization form can be collapsed and expanded as needed if users want to hide sections they’ve already completed.

Also note that all required fields are denoted by an asterisk. The system will alert users to any missing required fields prior to submission.

Once all required fields are completed and supporting clinical documentation attached, users should select the Review Authorization button. This takes users to a screen that allows them to review everything entered. Please note: The authorization has not been submitted at this point.

The user should review all their information. If they need to make changes, select the Edit Authorization button. Otherwise, select the Submit Authorization button. After submitting, the user is taken to a confirmation screen on which an authorization reference number appears.