2026 Notifications

• 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)

• 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)

• Update for Procedure Codes S9083 and S9088 (PDF)
• Update for HCPCS Code E0486 (PDF)
• Important Prior Authorization Updates (PDF)
• Battle Born State Plans: An Overview (PDF)
• Ambetter Provider Appointment Standards for Scheduling (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.