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  • Wellcare Authorization Form

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By a physician with a Drug Addiction Treatment Act (DATA) waiver** (UIN #) Drug Requested: SL Film Tab 8mg/2mg SL Film Tab 2mg/0.5mg SL Tab 8mg SL Tab 2mg Quantity: Sig: Start date of this PA: **Doses above 32mg per day will NOT be approved. 1. Primary Diagnosis: ICD-9: 2. Psychosocial Counseling (submit no.

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Questions & Answers

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Contact support

There are four easy options: Call the Dept. for Community Based Services (DCBS) at 1-855-306-8959. Visit a local DCBS office. You can find one online. Call kynect at 1-855-4kynect (459-6328). Update your contact information online.

Claim payment appeals must be submitted in writing to WellCare within 24 months of the date on the EOP. All supporting documentation must be submitted along with the claim payment appeal request.

Timely Filing Claims must be received within 12 months from the date of service (DOS) or six months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.

Expediting Clinical Appeals Call us at 1-855-852-7005 to expedite a clinical appeal.

The following Wellcare plans offer Medicare Advantage Prescription Drug plan coverage to Kentucky residents. Medicare Advantage plus Prescription Drug plans are an alternative way to get your Original Medicare.

You or your provider must call or fax us to ask for a Expedited Appeal. Call us at 1-877-389-9457 (TTY 711 or 1-877-247-6272). Or fax it to 1-866-201-0657. If you file your Expedited Appeal by phone, written notice is not needed.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232