Medical Policies and Authorizations - for Providers

Medical Policies and Authorizations

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»	Important Authorization Terms

»	Authorization Table

»	Utilization Management Tool

»	Medical Policy Overview

»	Medical Policies A - Z

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

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Medical Policies and Authorizations

has everything you need to submit pre-service review requests. Go there now!


Important Authorization Terms Learn about the various types of authorizations, and find out how and when to get the approvals you need.			Authorization Table View medical policies and criteria used by Wellmark, and learn whether pre-service review is required.

Utilization Management Tool Get an overview of Wellmark's tool for submitting pre-service review requests.			Medical Policy Overview Learn how medical policies are developed and used at Wellmark.

Medical Policies A-Z Determine which treatment, procedure, service or supply may be eligible for coverage.			InterQual® Criteria and SmartSheets™ Find out how to access the criteria used in pre-service reviews.

Pre-service Review for Out-of-Area Members Verify benefits, read applicable medical policies and initiate a pre-service review request.			Federal Employee Program (FEP) Find out which treatments, procedures, services, or supplies require prior approval for FEP members.

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»		Prior Authorization and Treatment Request Forms

»		Radiology Pre-Service Appeal/Post-Service Inquiry Process