Provider Updates

2026

• Poly-ACH Medicare Provider Tip Sheet (PDF)
• COB Medicare Provider Tip Sheet (PDF)
• DHS Bulletin: Prior Authorization Requirements for Blood Glucose Meters (PDF)
• Reminder to Verify Ambetter Member Eligibility (PDF)
• Authorization Removal Updates effective April 1, 2026 (PDF)
• Ambulance Non-Emergency Transportation Reminder (PDF)
• Nursing Facility Per Diem Transportation Reminder (PDF)
• Policy Updates Less Restrictive Effective March 1, 2026 (PDF)
• 2026 NCQA CHC Ambetter Notification (PDF)
• PA Health and Wellness to Provide Statewide CHIP Coverage Starting Jan. 1 2026 (PDF)

2025

• Ambetter Change List Provider Notification Effective April 1, 2026 (PDF)
• Ambetter Change List Provider Notification Effective February 1, 2026 (PDF)
• CHC Change List Provider Notification Effective April 1, 2026 (PDF)
• Wellcare Change List Provider Notification Effective April 1, 2026 (PDF)
• Patient Analytics Retirement December 31,.2025 (PDF)
• CHC Prior Auth Change List Effective February 1, 2026 (PDF)
• Wellcare Telehealth Extension (PDF)
• DHS Clinical Policy Updates - Obesity Treatment Agents, GLP-1s, and DPP-4 Inhibitors (PDF)
• High Cost Drugs Policy Update November 2025 (PDF)
• Provider POA Bulletin (PDF)
• Wellcare Spendables via Care Credit (PDF)
• Provider Self-Audit Protocol Reminder (PDF)
• 2026 Wellcare Alternative Covered Drugs (PDF)
• Continuity of Care (CoC) Program Update October 2025 (PDF)
• Ambetter from PA Health and Wellness Confirm Member Eligibility Steps 2025 (PDF)
• Prepayment Claim Review Update effective December 1, 2025 (PDF)
• Ambetter Important Billing Code Update for CPT 0449U Bulletin Effective January 1, 2026 (PDF)
• CMS Prior Authorization Change Summary effective January 1, 2026 (PDF)
• Medicare Prior Auth Change List effective October 10, 2025 (PDF)
• Lift Chair (W0137) Auth Process Provider Notification September 2025 (PDF)
• TruCare Outage October 10, 2025 (PDF)
• Availity Editing Services Wellcare August 2025 (PDF)
• Provider Payment Policy Notification PA.CP.MP.121 Homocysteine Testing (PDF)
• Wellcare By Allwell Wellsky tango Post-Acute Care Facility Notice (PDF)
• Wellcare By Allwell Provider Wellsky tango Home Health Notice (PDF)
• Wellcare by Allwell Provider Announcement Networkwide (Referral Sources) (PDF)
• Kidney Health Management HealthMap Notice (PDF)
• Wellcare Medical Oncology Radiology Auth Updates with Evolent effective September 2025 (PDF)
• Ambetter and Wellcare Auth Updates with Evolent for IPM effective September 2025 (PDF)
• EVV VBP Time Period Change (PDF)
• Ambetter Skin Substitutes Policy and Prior Authorization Update (PDF)
• CHC Prior Authorization Updates Effective September 2025 (PDF)
  
• Ambetter Prior Authorization Updates Effective September 2025 (PDF)
• PHW Pharmacist Provider Status How To Guide (PDF)
  
• 2025 Alternative Covered Drugs (PDF)
  
• Medicare PA Standardization List Effective July 2025 (PDF)
  
• Provider Notification Optum CPI April 2025 (PDF)
  
• Nursing Facility VBP April 2025 (PDF)
• Nursing Facility Incentive Extension March 2025 (PDF)
  
• OLTL Critical Incident Management Notification of Requirements Clarification (PDF)
  
• Ambetter Routine Foot Care Update (PDF)
• Nursing Facility Payment Incentive Update (PDF)
• Nursing Facility Retro Rate Adjment Q3-Q4 2024 (PDF)

Commonwealth Coronavirus Resources

• PA Department of Health
• DHS Provider Quick Tips

Federal Coronavirus Resources

Centers for Disease Control

Additional Coronavirus Resources

• Provider Accessibility Initiative COVID-19 Web Series
• COVID-19 and People with Disabilities
• Essential Services: Maintaining Access to Personal Attendants During the COVID-19 Epidemic

Additional Resources

• U.S. Department of Health & Human Services
• Small Business Administration Disaster Assistance

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: H2915 (PDF)
• Wellcare Prior Authorization Metrics Summary: H2915 (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.

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