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