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All files are available as Adobe Acrobat PDF unless otherwise stated.

Provider Enrollment


Prior Authorization

Prior Authorization for Residential and Inpatient SUD Treatment

Pay for Performance

Care Management

Member Management

The Full Panel Add and Hold Request form and Member Disenrollment form are now available on the Provider Portal. Copies of completed paper forms are no longer accepted via fax or email. Please login to your portal account to complete these forms.


To request a printed copy of one of these forms, please call Provider Services.

Ambetter and Wellcare and Wellcare Complete Manuals & Forms

For additional Ambetter information, please visit our Ambetter website.

For additional Wellcare infomation, please visit our Wellcare website.

For additional Wellcare Complete information, please visit out Wellcare Complete website.

Last Updated: 06/26/2024