Changes to Medicare Prior Authorization Requirements

Date: 12/29/22

To help support the transition of care post hospitalization, Wellcare By Trillium Advantage and Wellcare By Health Net Health Plans are waiving the prior authorization requirements for the services listed below for our Medicare members:

• The prior authorization requirement for Skilled Nursing Facility (SNF) admission has been waived for Medicare members.
• The existing waiver of prior auth for Trillium Community Health Plan Medicaid members remains in effect. 
• SNFs should notify Trillium/Health Net when a Medicare or Medicaid member is admitted to a SNF. The first seven days of the stay will be automatically approved. SNFs should notify via fax on the day of admission and include the patient name, DOB, ID Number, Name of admitting skilled nursing facility and admission date. 
  • Wellcare By Health Net Health Plan Members Fax SNF admission notification to 1-844-386-6465
  • Wellcare By Trillium Advantage plan members fax SNF admission notification to 1-844-293-9155
• Trillium/Health Net will begin concurrent review on day seven of the SNF stay.

We will continue to work in close partnership with hospitals, facilities and providers to ensure ease of access to care for our Medicare members.  

Thank you for your partnership in serving our members. If you have questions regarding the information contained in this update, please contact Wellcare By Health Net Provider Services at 1-888-445-8913 and Wellcare By Trillium Advantage  Provider Services at 1-844-867-1156.