2026 Notifications
- Updates to Policy CC.VP.14 - Scanning Computerized Ophthalmic Diagnostic (Medicaid and Marketplace only) (PDF)
- Grant Funding Opportunity for Nevada Rural Healthcare Providers (PDF)
- Project Echo Nevada presents: Developmental Pediatrics Echo Summer 2026 (PDF)
- Leveling of Care: Emergency Department Evaluation and Management Overcoding for Facility Services (PDF)
- Ultrasound in Pregnancy (CP.MP.38) (PDF)
- ADHD Assessment and Treatment (CP.BH.124) (PDF)
- More Restrictive Clinical Policies (PDF)
- Services FAQs for Providers (PDF)
- Save the Date: Annual Provider Survey (PDF)
- Project Echo Nevada presents: Syphilis and HIV in Primary Care Echo (PDF)
- Project Echo Nevada presents: Heart Failure in Primary Care Echo (PDF)
- Project Echo Nevada presents: Developmental Pediatrics Echo (PDF)
- Updated Evolent Prior Authorization Requirements (PDF)
- Project Echo Nevada presents: School Based Mental Health Echo Series (PDF)
- Prior Authorization Update for Evolent (PDF)
- Prior Authorization Vendors: Providers' Guide (PDF)
- Nevada Medicaid Swift Revalidation of Select High Risk Providers (PDF)
- Swift Revalidation of Select Medicaid Providers FAQ (PDF)
- Claims Processing Update on Psychotherapy Procedure Codes (PDF)
- Prior Authorization Updates effective 10.01.26 (PDF)
- Reminder: Billing Requirements for Provider Type 85 – Rendering Practitioner Accuracy (PDF)
- Notification of Configuration Impact Psychotherapy Services - (PDF)
- Practitioner AccuracyNotice of Claims Processing Review – Home Health (HH) and PCS Providers (PDF)
- Important Reminder: Ordering, Prescribing, and Referring (OPR) Requirements (PDF)
- Ordering, Prescribing and Referring (OPR) FAQs (PDF)
- Provider Reminder: Ordering, Prescribing, and Referring Provider Enrollment (PDF)
- Revision to Clinical Policy: Applied Behavior Analysis (PDF)
- Changes to Level 3 SUD Authorizations (PDF)
- Home Health and Personal Care Attendant (PCA) providers: EVV Payor ID changes effective 4/1/26 (PDF)
- For Nursing Facilities: Ventilator Dependent Level of Care (LOC) Authorizations are limited to 180 days from date LOC was approved (PDF)
- SafeRide Flyer to Share with Patients (PDF)
- SafeRide Postcard to Mail/Share with Patients (PDF)
- Provider Introduction to Conversio Health for SilverSummit
- Important Prior Authorization Updates (PDF)
- Nevada Medicaid single PDL FAQ (PDF)
- Prior Authorization Updates effective 2.1.26 (PDF)
- CMS Prior Authorization Change Summary effective 1.1.26 (PDF)
- Inpatient and Post-Acute Care Pre-and Post-Decision Peer-to-Peer Discussions (PDF)
- Medicare Request for Information Fax Tip Sheet (PDF)
- Special Supplemental Benefits for the Chronically Ill (SSBCI) (PDF)
- SSBCI Provider Attestation Form (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Appeals/Reconsiderations (Medical) and Grievances Guide (PDF)
- 2026 Alternative Covered Drugs
- Important Prior Authorization Updates (PDF)
- Wellcare Provider Appointment Standards for Scheduling (PDF)
- CMS Prior Authorization Change Summary Effective 01/01/26 (PDF)
CMS Interoperability & Prior Authorization Final Rule: CY2025 Prior Authorization Requirements Reports and Metrics Summaries
In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.
Reports:
- Wellcare CMS Final Rule 0057-F Prior Authorization Requirements: H0351 (PDF)
- Wellcare Prior Authorization Metrics Summary: H0351 (PDF)
The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.