[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-287362-105":53,"doc-detail-287362-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","wellmed-prior-authorization-requirements-effective-july-1-2026","WellMed Prior Authorization Requirements Effective July 1, 2026","","WellMed Prior Authorization Requirements effective July 1, 2026 outlines when participating care providers must obtain pre-approval for inpatient and outpatient services. It states that prior authorization is not required for emergency or urgent care and explains how requests, eligibility, and medical benefits should be verified before submitting PA. The document describes inclusion of specific in-network benefit plans, delegated arrangements in Texas and New Mexico, and the process for standard, expedited, and unplanned admissions.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/wellmed-prior-authorization-requirements-effective-july-1-2026/287362/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/wellmed-prior-authorization-requirements-effective-july-1-2026/287362.png","ImageObject",442,249,{"name":88,"@type":89},"Jordan Avery","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-27","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Is prior authorization required for emergency or urgent care?","Question",{"text":108,"@type":109},"No. Prior authorization is not required for emergency or urgent care.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When should providers submit standard prior authorization requests?",{"text":113,"@type":109},"For plans administered by WellMed, submit a request at least 14 days before the planned date of service, using the web portal (ePRG).",{"name":115,"@type":106,"acceptedAnswer":116},"How do expedited requests differ from standard requests?",{"text":117,"@type":109},"Expedited requests should be submitted through the ePRG web portal and only when waiting under the standard review timeframe may seriously jeopardize the patient’s life or health or ability to regain maximum function.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},287362,1790489228,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":135,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":142},1099523882367,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","WellMed Prior Authorization  \nRequirements Effective July 1, 2026  \nGeneral Information  \nThis list contains prior authorization requirements for participating care providers for inpatient and outpatient services. Prior authorization is not required for emergency or urgent care. All listed below changes are part of WellMed ongoing Prior Authorization Governance process to evaluate our medical policies, clinical programs, health benefits, and Utilization Management information.  \nAlthough prior authorization requirements may be removed codes, post-service determinations may still be applicable based on criteria published in medical policies, local/national coverage determination criteria, and/or state fee schedule coverage.  \nFor more information about changes in WellMed Prior Authorization program and current prior authorization requirements, please visit WellMed provider portal ePRG.  \nPlease verify Eligibility and Medical Benefits before requesting prior authorization (PA)  \nMembers must utilize a contracted provider for all non-emergent services unless the non-contracted provider has obtained prior authorization prior to rendering services.  \nIncluded Benefit Plans  \nWellMed Prior Authorization Requirements apply to the following Benefit Plans for in-network services 1  \n• For UnitedHealthcare Medicare Advantage Benefit Plans Delegated to WellMed Medical Management in Texas & New Mexico, WellMed Texas Prior Authorization Requirements will apply.  \n• For Cigna Medicare Advantage Benefit Plans Delegated to WellMed Medical Management in Texas, WellMed Texas Prior Authorization Requirements will apply.  \n1 Subject to Change  \n\n| How to Submit Prior Authorization Request |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| |  | For plans administered by WellMed, submit a request at least 14 days before the planned date of service. View prior authorization request requirements and submit your request and clinical information using preferred method [https://eprg.wellmed.net](https://eprg.wellmed.net) |  |  |  |  |\n| \u003Cbr>Standard Expedited |  |  |  |  |  |  |\n| | For prompt determination, submit ALL STANDARD requests using the Web Portal (ePRG):\u003Cbr>[https://eprg.wellmed.net](https://eprg.wellmed.net)\u003Cbr>[Phone 1-877-299-7213](Phone 1-877-299-7213) |  |  | | For prompt determination, submit ALL EXPEDITE requests using the Web Portal (ePRG): [https://eprg.wellmed.net](https://eprg.wellmed.net)\u003Cbr>ONLY submit EXPEDITED requests when the health care provider believes that waiting for a decision under the standard review time frame may seriously jeopardize the life or health of the patient or the patient’s ability to regain maximum function.\u003Cbr>Phone 1-877-299-7213 |  |\n|  | For plans administered by WellMed, Unplanned Hospital Admission notification required.\u003Cbr>Please notify WellMed no later than one business day after admission using preferred method for notifications: (ePRG) Web Portal [https://eprg.wellmed.net](https://eprg.wellmed.net) |  |  |  |  |  |\n| \u003Cbr>Unplanned Inpatient Admissions |  |  |  |  |  |  |\n|  (ePRG) Web Portal\u003Cbr>[https://eprg.wellmed.net](https://eprg.wellmed.net)\u003Cbr> Fax: 1-877-757-8885\u003Cbr> Phone:1-877-490-8982 |  |  |  | | Medical Records :ONLY send Medical Records associated with an inpatient admission to\u003Cbr>(ePRG) [https://eprg.wellmed.net](https://eprg.wellmed.net)[ ](https://eprg.wellmed.net)[Or Fax 1-844-567-6855](Or Fax 1-844-567-6855) . |  |\n| \u003Cbr>Out-of-Network Services\u003Cbr>Procedures and Services Additional Information How to obtain Prior Authorization |  |  |  |  |  |  |\n| All out-of-network inpatient and certain outpatient hospital admissions, surgeries, procedures, referrals, evaluations, specialty services and/or treatments |  |  | Prior Authorization may be required for a health care provider, hospital or physician who is not contracted with WellMed. |  |  |  Phone 1-877-299-7213 |\n\n\n| Inpatient Admissions |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| The following services require","cbCailL8jaNlwW28","https://ap.wps.com/l/cbCailL8jaNlwW28","pdf",614280,10,20,"English","# General Information\n## Included Benefit Plans\n# How to Submit Prior Authorization Request\n## Standard and Expedited Requests\n## Unplanned Hospital and Inpatient Admissions\n# Inpatient Admissions Requiring Prior Authorization\n## Unplanned Inpatient Admissions\n# Other Services That May Require PA","[{\"question\":\"Is prior authorization required for emergency or urgent care?\",\"answer\":\"No. Prior authorization is not required for emergency or urgent care.\"},{\"question\":\"When should providers submit standard prior authorization requests?\",\"answer\":\"For plans administered by WellMed, submit a request at least 14 days before the planned date of service, using the web portal (ePRG).\"},{\"question\":\"How do expedited requests differ from standard requests?\",\"answer\":\"Expedited requests should be submitted through the ePRG web portal and only when waiting under the standard review timeframe may seriously jeopardize the patient’s life or health or ability to regain maximum function.\"}]","WellMed Prior Authorization Requirements Effective July 1, 2026 | PDF",1789632206,7]