Electronic Prior Authorizations
Providers may use SureScripts, CoverMyMeds, or ExpressPath as Prior Authorization Portals, which makes it easy for to submit fully electronic prior authorization requests right away. There is no EHR needed, no technology integration, and no cost to providers — just quick and easy electronic prior authorizations. Please confirm that the member has updated their address on file with Wellfleet prior to submission to avoid any denials due to missing address information.
As an alternative to an electronic submission, you may complete a Prior Authorization Request Form to request a prior authorization. The Prior Authorization Request Form is to be used by providers to obtain coverage for a formulary drug requiring prior authorization (PA), a non-formulary drug for which there is no suitable alternative available, or any overrides of pharmacy management procedures such as step therapy, quantity limit or other edits. The form can be completed an faxed to (877) 251-5896. Alternatively, a prior authorization request may be initiated by calling (877) 640-7938 with the information requested in the form.
If you are looking for a state-specific prior authorization request form not listed below, additional forms can be found here: State-Specific PA Forms »