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Reinstatement of Prior Authorization Requirements

Dear Provider,

The Department for Medicaid Services (DMS) has notified the Medicaid Managed Care Organizations (MCOs) that prior authorization requirements will be reinstated effective August 1st, 2020 for all non-Behavioral Health services and procedures. MCOs will continue to waive all Behavioral Health and SUD (Substance Use Disorder) services and procedure requirements until further notice. All other services regarding inpatient and outpatient medical procedures will require authorization in the same manner they did prior to the COVID-19 Public Health Emergency (PHE) Orders implementation.

Prior Authorization is the process of obtaining approval in advance of rendering a service. It allows for efficient use of covered healthcare services and ensures that Members receive the most appropriate level of care at the most appropriate setting. There are multiple ways to initiate a Prior Authorization with WellCare of Kentucky. The most efficient manner is through our Provider Portal. Please refer to our Quick Reference Guide for additional information about Prior Authorizations on our public website.

WellCare of Kentucky would like to thank all of you who are working on the front lines during these unprecedented times. If you have any questions, please contact your Provider Relations Representative.