We may extend the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest.įor a decision about payment for Part D prescription drugs you already received: After we receive your appeal, we have 14 calendar days to make a decision. If we find in your favor, we must issue payment within 60 calendar days of the date of receipt of your appeal request.įor a standard decision about authorizing medical care: After we receive your appeal, we have up to 30 calendar days to make a decision, but will make it sooner if your health condition requires. How quickly we decide on your appeal depends on the type of appeal:įor a decision about payment for services you already received: After we receive your appeal, we have 60 calendar days to reconsider our decision.
WELLCARE MEDICARE TIMELY FILING LIMIT HOW TO
Please include copies of any additional information that may be relevant to your appeal and mail, email or fax to the address(s) and/or fax number listed in the How to File section below. Completion of this form is not required to file an appeal. Or you may complete the Medical Appeals & Grievance Department Request for Reconsideration form in place of a letter. To file a standard appeal, you must send a written request stating the nature of the complaint, giving dates, times, persons, places, etc.
Allwell may accept an appeal or redetermination beyond 60 days if you show Allwell good cause for an extension. You need to file your appeal within 60 calendar days from the date on the coverage determination/organization determination notice (denial letter) you received. A member can revoke the authorization at any time.Īn "appeal" is the type of complaint you make when you want us to re-evaluate and change a decision we have made about what benefits are covered for you or what we will pay for a benefit. The Appointment of Representative Form is valid for one year from the date indicated on the form. The form will be valid during the entire appeal/grievance process. Wellcare By Allwell Medicare requires a copy of the completed and signed Appointment of Representative Form to process an appeal filed by the member’s representative. The surrogate will need to give Wellcare By Allwell Medicare copies of the legal papers supporting his or her status as the member’s authorized representative. (By clicking on this link you will be leaving the Wellcare By Allwell website.) If a member is incapacitated or legally incompetent a surrogate is not required to submit an Appointment of Representative Form.
Prior Authorization, Step Therapy, & Quantity Limitations.Coverage Determinations and Redeterminations.
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