Get Wellcare Dme Authorization Form

The Wellcare Dme Authorization Form is essential for obtaining necessary medical equipment and services. This guide provides clear, step-by-step instructions for completing the form online, ensuring you can navigate the process efficiently.

Follow the steps to complete the Wellcare Dme Authorization Form online.

1. Press the ‘Get Form’ button to access the Wellcare Dme Authorization Form and open it in your preferred editor.
2. Begin filling out the 'Member' section. Enter the Member Plan ID, today's date, member's last name, first name, phone number, and date of birth.
3. Next, navigate to the 'Requesting Provider' section. Here, provide the primary care provider's ID, type, last name, first name, phone number, specialty, and fax number.
4. In the 'Treating Provider' section, fill in the treating provider's ID, specialty, last name, first name, address (including city, state, and ZIP code), phone number, and fax number.
5. Proceed to the 'Facility' section, where you may specify the facility type (Office, OP, Hospital, Free Standing Facility, Home, Ambulette). If necessary, you can check the box to skip this section and allow the plan to assign a facility.
6. In the 'Service Requested' section, indicate the planned date of service, primary ICD-9 code, CPT-4 / HCPC code, and the description of the procedure or services required.
7. Fill in the visits and frequency for the requested service. If applicable, attach a pertinent clinical summary that provides additional procedures codes and necessary member information.
8. Once all information is entered, review the form for accuracy. Finally, save your changes. You can choose to download, print, or share the form as needed.

Complete your Wellcare Dme Authorization Form online today for a smoother process!