Wellcare outpatient authorization request form 2026

1. Click ‘Get Form’ to open the wellcare outpatient authorization request form in the editor.
2. Begin by checking one of the service types required, such as Consultation or Diagnostic Testing. This helps categorize your request.
3. Fill in the 'Requesting Provider' section with your details, including Today’s Date, Member Plan ID, and Member information like Last Name and DOB.
4. Complete the 'Provider' section by entering the Provider ID, Type (PCP or Specialist), and contact details for the provider.
5. If applicable, provide information about the Treating Provider and Facility. You can skip this section if you want the Plan to assign them.
6. In the 'Service Requested' section, specify Planned Date of Service, Primary ICD-9 Code, CPT-4/HCPC Code, and a detailed description of the procedure.
7. Finally, include any pertinent clinical summaries or attach supporting documents as necessary before submitting your request.

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