Pre-Auth Check

Use our pre-auth check tools to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can log into the secure Provider Portal and submit online.

CMS Interoperability & Prior Authorization Final Rule: CY2025 Prior Authorization Requirements Reports and Metrics Summaries

In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.

Reports:

• Wellcare CMS Final Rule 0057-F Prior Authorization Requirements: H2174 (PDF)
• Wellcare Prior Authorization Metrics Summary: H2174 (PDF)

The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.