Wellcare By Delaware First Health (AIP) Pre-Auth

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

The following services need to be verified by Evolent 

Complex imaging, MRA, MRI, PET, and CT scan

Musculoskeletal services and Pain Management

The following services need to be verified by Evolent

Cardiology, Medical and Radiation Oncology

Cardiac services for Members 18 years and older

For non-participating providers, Join Our Network.

Are services being performed in the Emergency Department or Urgent Care Center, or the services for dialysis or Hospice?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are anesthesia services being rendered for pain management or services in the office rendered by a non-participating provider?
Is a non-par provider rendering services other than flu/pneumonia shots?

To submit a prior authorization Login Here.