Medical management

The WellFirst Health — provided by SSM Health Plan — Medicare Advantage plan prior authorization form can be used to to request authorization of services that require prior authorization, including medical drug injectables. See to the WellFirst Health Medical Service List for services that require prior authorization and to submit prior authorization requests.

WellFirst Health Medicare Advantage Prior Authorization Form

WellFirst Health Medicare Advantage Dean Advantage Prior Medical Services Authorization Service List

WellFirst Health Medicare Advantage Part B Step Therapy

WellFirst Health medical policies

Services will be reviewed according to the Medicare Coverage Guidelines, established by the Centers for Medicare & Medicaid Services (CMS). According to the guidelines, all medical care, services, supplies and equipment must be medically necessary. 

In scenarios where CMS does not provide guidance on the particular medical care, service, supplies and equipment, WellFirst Health  will use MCG (formerly Milliman Care Guidelines) criteria or a WellFirst Health medical policy. See the WellFirst Health Medical Services Prior Authorization List to access the medical policies relevant to the services you are requesting.

Additional information 

Additional Information about medical management can be found on the WellFirst Health Plan Medical Management page. Key resources include:

Questions? Contact us.

Senior man using phone and laptop in his living room.Members
Talk with our Customer Care Center at 1-877-301-3326 (TTY:711).
 
Not a member?
Talk with a WellFirst Health Medicare sales rep at 1-833-551-0565. You can also call to ask for information in alternate formats and languages. 

Mailing address

WellFirst Health Medicare Advantage
PO Box 56099
Madison, WI 53705-9399
 
View our Medicare disclaimers

H8019_wellfirstbenefits.com
Updated 10/1/20