Provider Information
WellCare of North Carolina (WellCare) provides behavioral health benefits to members enrolled in our Medicaid plan. We are committed to quality service and partnership with providers to ensure members get the most of their benefits.
Authorizations
Some behavioral health services may require prior authorization, including services provided by non-participating providers. Obtaining appropriate authorization is essential to providing needed care.
WellCare uses the following:
- North Carolina Behavioral Health Clinical Coverage Policies
- WellCare Clinical Coverage Guidelines
- American Society of Addiction Medicine, Inc. (ASAM): Assesses level of care determinations for substance-related disorders.
- InterQual
Behavioral Health Resources
Beginning on 6/1/25, the Behavioral Health Pre-Cert phone line will be discontinued. Requests for inpatient or residential will no longer have a live review for medical necessity when calling in the admission. Authorization requests, including all supporting clinical documentation, need to be submitted through the provider portal or via fax. The behavioral health utilization team will reach out if additional information is needed to complete the medical necessity review.