Wellcare pcp change form 2025

1. Click ‘Get Form’ to open the wellcare pcp change form in the editor.
2. Begin with Part 1: Member Information. Fill in your last name, first name, WellCare Member ID, phone number, middle initial, and date of birth. Ensure all required fields are completed legibly.
3. Proceed to Part 2: PCP Change Request. Enter the requested PCP's full name and their WellCare Provider ID. Again, ensure that all required fields are filled out clearly.
4. In Part 3, list any additional family members requesting a change to the same PCP by providing their names, dates of birth, and WellCare Member IDs.
5. For Part 4: Reason for PCP Change Request, check one box that best describes your reason for the change. If 'Other' is selected, provide a brief explanation.
6. Finally, print your name or responsible party's name, sign where indicated, and include the date. Remember to attach a copy of your member ID card before submission.

Start using our platform today for free to streamline your wellcare pcp change form process!