Medical management

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


Our 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, we will use MCG (formerly Milliman Care Guidelines) criteria or a WellFirst Health — Provided by SSM Health Plan — medical policy. See the our 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 our 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 one of our Medicare sales reps at 1-833-551-0565 (TTY:711) You can also call to ask for information in alternate formats and languages. 

Mailing address

WellFirst Health — Provided by SSM Health Plan
PO Box 56099
Madison, WI 53705-9399
 
View our Medicare disclaimers.

H8019_wellfirsthealth.com
Updated 5/27/21