Wellmed Changes Pre-authorization Requirements

As of January, 2020, Wellmed has sent notifications to providers in Florida and Texas that it will now require practices to obtain prior authorization for many procedures, including cataract surgery and YAG laser capsulotomy.  This change to the Wellmed prior authorization process will now require patients to obtain counseling from their primary care providers (PCP) regarding the risk of surgery during the current public health emergency.  Wellmed states that it will contact the PCP to confirm that the counseling has occurred, prior to granting authorization to the surgeon and facility for the procedures.

As a result of this new process, the surgeon’s office will need to call Wellmed’s authorization line to see if patient plans require authorization for the outpatient surgery planned.  As noted above, this includes cataract surgeries and YAG laser capsulotomy.  When we called Wellmed to confirm this, the company stated that they do not have a list of CPT codes that require approval, but that offices should call the number below, or log onto the Wellmed physician portal with the planned CPT codes to verify if action should be taken before the procedure is performed.  The company has also stated that they will not be backdating authorizations after surgeries have been completed, and they urge you to contact Wellmed before performing the procedure.

The number to call is 1-877-299-7213 or log onto the physician portal at www.eprg.wellmed.net

We are available and happy to assist you with issues such as this and other topics related to eye care during this public health emergency.  Stay safe.

www.corcoranccg.com (800) 399-6565

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