Pre-Auth Check

Use our tool to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can access our login to submit online.

Pre-Auth Check Tool - Ambetter | Medicaid | Medicare

CMS Interoperability & Prior Authorization Final Rule: CY2025 Prior Authorization Requirements Reports and Metrics Summaries

In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.

Reports:

• Wellcare CMS Final Rule 0057-F Prior Authorization Requirements: H6550 & H9387 (PDF)
• Wellcare Prior Authorization Metrics Summary: H6550 (PDF)
• Wellcare Prior Authorization Metrics Summary: H9837 (PDF)

The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.