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Manage Authorizations

The majority of JivaTM log-in and authorization request submission issues have now been resolved. Utilizing Jiva is the most effective means of submitting and having authorization requests processed and approved. If you are having issues submitting authorization requests in Jiva, contact Wellmark Technical Support at 800-407-0267.

 

Wellmark is only accepting faxed medical authorization requests that are defined as expedited. Requests are considered expedited when a delay in medical care or treatment can:

  • Seriously jeopardize the life or health of the member or the member's ability to regain maximum function, OR
  • Subject the member to severe pain that cannot be adequately managed without the care or treatment requested.

 

Some medical services, procedures, durable medical equipment (DME), and drugs require approval before they can be covered by your patients' benefits.

 

View important details about authorization

 

Out-of-Area Member Authorizations

 

Start the Authorization Process

Step 1

Verify if authorization is required.

 

Use the medical or drug authorization table to determine if you need authorization.

 

Medical Authorization Table (Procedures, Imaging, and DME)

Drug Authorization Table (Medications and drugs)

 

Step 2 Submit an authorization request

 

Submitting online using Wellmark's secure tools is easy and only takes a few minutes.

 

Log in to submit an authorization request

 

Medical

Drug

 

Step 3

Check the status of an authorization

 

Log in to check the status or see if further action is needed.

 

Medical

Drug

 

Learn more about response times and notifications

 

Note: Upon receiving approval, you will be given an authorization number. Please reference this number on all claims related to the specific procedure or service requiring prior approval. Also, remember that services determined as not medically necessary, or investigational or experimental, are the liability of the provider.

 

 

User Guides & Resources

Medical Authorization User Guide (Jiva) pdf

Jiva quick guide for submitting inpatient (IP) requests pdf

Jiva quick guide for submitting outpatient (OP) requests pdf

Jiva quick guide for submitting out of network (OON) requests pdf

InterQual® clinical review training video Play Video

Drug Authorization User Guide (NovoLogix) pdf

NovoLogix FAQ pdf

NovoLogix Training Video Play Video

 

Related Links

Imaging Services Pre-Authorization Code Groupings secure

Important Authorization Terms

InterQual® Criteria and SmartSheetsTM

Medical Policies A-Z

Medical Policy Overview

Pre-Service Review for Out-of-Area Members secure

Prior Approval for Federal Employee Program (FEP) Members

Radiology pre-authorization requests Q&A secure

SmartSheetsTM secure

Utilization management-related webinars secure


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