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Get Wellcare Pcp Change Form
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How to fill out the Wellcare PCP Change Form online
The Wellcare PCP Change Form is an essential document for members who wish to change their primary care provider. This guide provides clear, step-by-step instructions for filling out the form accurately and efficiently online.
Follow the steps to complete the Wellcare PCP Change Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part 1, complete the member information section. Provide your last name, first name, WellCare member ID number, phone number with area code, middle initial (if applicable), and date of birth. All fields marked with an asterisk are required.
- In Part 2, fill out the PCP change request section. Enter the full name of the requested primary care provider and their WellCare provider ID number, ensuring that all required fields are completed.
- If applicable, move to Part 3 to request a change for additional family members. For each family member, provide their name, date of birth, and WellCare member ID number.
- In Part 4, indicate the reason for the PCP change request by checking the appropriate box. If 'Other' is selected, provide additional details.
- Print the name of the member or responsible party and provide a signature for verification. If a responsible party is signing, ensure their name matches what WellCare has on file.
- Finally, include the date and ensure you have a copy of the member ID card ready to submit with your form. Once completed, follow the provided directions to fax the form to the appropriate number.
Complete your Wellcare PCP Change Form online today to ensure your healthcare preferences are met.
To change your primary care physician in Wellcare, fill out the Wellcare Pcp Change Form available on their site. Ensure that you provide all required information for a smooth transition. After submitting the form, monitor your status through your Wellcare account or contact customer support for any follow-up questions.
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