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Medical Policies and Authorizations

The secure Utilization Management page 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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  • Change Request Tool
  • Recredentialing Tool
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WINS

Quick Links

» Authorization Table
» Submission Status Tracker
» Drug Information
» Education
» Find a Doctor or Hospital
» Forms
» ICD-10
» Medical Policies
» Provider Guide
» WINS

Related Information

» Prior Authorization and Treatment Request Forms
» Radiology Pre-Service Appeal/Post-Service Inquiry Process
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