8/5/2026
Wellcare, Evolent are updating Oncology Services starting October 1, 2026 to enhance efficiency and reduce administration burden.
Wellcare in collaboration with Evolent is implementing updates to how oncology services are reviewed and administered to enhance the member and provider experience. These changes reflect a shared commitment to improving efficiency, reducing administrative burden, and supporting timely, clinically appropriate care decisions.
What's Changing?
Denial Determinations for Oncology Services: Effective October 1, 2026, Evolent will issue denial determinations for oncology authorization requests that do not meet clinical criteria.
For requests received prior to October 1, 2026, Evolent will continue to issue Recommended Adverse Determinations (RADs) when clinical criteria are not met and Wellcare will provide the final determination of the request.
Please continue to submit grievances and appeals directly to Wellcare.
Pharmacy Benefit (Part D) Scope Update
Effective October 1, 2026, Evolent’s oncology review scope will be limited to medical benefit (Part B) medications only. All pharmacy-dispensed (Part D) drugs must be submitted directly to Wellcare, in accordance with plan guidelines.
Requests received prior to October 1, 2026, will be administered by Evolent under the current process.
If you have questions or want additional information, please contact Evolent by calling 1-888-999-7713 or emailing practicesuccess@evolent.com.
¿Tiene alguna pregunta?
Wellcare has a wealth of resources available to help answer your questions and address your concerns:
- Provider Support: Finding the Right Contact
- Provider Services: Call 1-855-538-0454
- Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
- Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
- Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
- Provider News: Bookmark Wellcare Provider Bulletins and Sunshine Health Provider News to keep up with the latest updates.
- Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
- Provider Resources: Visit Wellcare Provider Resources to find provider manuals, important forms, scheduling standards and other resources.
