Get Wellcare Change Pcp Form

The Wellcare Change PCP Form allows members to request a change of their primary care provider (PCP) efficiently. This guide will assist you in accurately completing the form online to ensure proper processing of your request.

Follow the steps to complete the Wellcare Change PCP Form online.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by filling out Part 1, which is the Member Information section. This includes entering the last name, first name, Wellcare Member ID number, contact phone number, middle initial (if applicable), and date of birth. Ensure accuracy in each field, as incomplete or incorrect submissions will hinder processing.
3. Proceed to Part 2, labeled PCP Change Request. Here, you will need to enter the requested PCP's full name and their Wellcare Provider ID number.
4. In Part 3, if applicable, list any family members who are also requesting a change to the same PCP. Include their names, dates of birth, and Wellcare Member ID numbers.
5. Move to Part 4, which asks for the reason for the change request. Make sure to select one of the provided options that best describes your reason for wanting to change PCPs.
6. Print your name and provide your signature, along with the date at the provided spaces. If you are not the biological parent, you must ensure that the name of the responsible party matches the records held by Wellcare.
7. Before submitting, double-check that you have filled in all required fields and signed the form. Additionally, attach a copy of your member ID card as instructed.
8. Once you have completed the form and attached the necessary documents, you may proceed to submit it as per the instructions provided.

Complete your Wellcare Change PCP Form online today to ensure your request is processed effectively.