Effective October 1, 2023: Changes to Medicare Prior Authorization List

Date: 08/31/23

Wellcare By Trillium Advantage and Wellcare By Health Net Health require prior authorization (PA) as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all Medicare products offered by Wellcare By Trillium Advantage and Wellcare By Health Net Health.

Wellcare By Trillium Advantage and Wellcare By Health Net Health is committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. 

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.       

For complete CPT/HCPCS code listing, please see Online Prior Authorization Tools on our website:

• Wellcare By Health Net Prior Authorization
• Wellcare By Trillium Advantage Prior Authorization

View this Medicare Prior Authorization Change Summary notice (PDF) for the changes to prior authorization requirements effective 10/1/2023.

Thank you for your partnership in serving our members. If you have questions regarding the information contained in this update, please contact Wellcare By Health Net Provider Services at 1-888-445-8913 and Wellcare By Trillium Advantage Provider Services at 1-844-867-1156.