WellFirst Logo
Login
  • About us
      • Overview

      • WellFirst Health
      • About us
      • Health plan 101
      • News
      • Notables Member Newsletter
      • Media contacts
      • Contact us
      • Resources
      • Business transparency
      • Drug exception time frame
      • Premium refunds
      • Grace period and claims
      • Retroactive denials
      • Member claims
      • Web
      • Website privacy policy
      • Website terms of use
      • Glossary of terms
      • Provider term glossary
      • Legal
      • Legal resources
      • Privacy policy
      • Member rights & responsibilities
      • Fraud & health care
      • Terms and conditions
  • Find a doctor
      • Overview

      • Online directories
      • Find a doctor
      • Find a location
      • Find a pharmacy
      • Resources
      • Continuity of care
      • Coronavirus (COVID-19)
      • 24-hour nurse advice line
      • E-Visit
      • Out-of-area coverage
      • PDF directories
      • Individual EPO-Marketplace/Commercial
  • Individuals & Families
      • Overview

      • Shop plans
      • Individual & family home
      • Direct plans
      • Marketplace plans
      • New to WellFirst Health?
      • Special enrollment
      • Individual & family kit request
      • Resources
      • Individual & family members
      • Cost estimator
      • Pay your premium
      • Prior authorization
      • Traveling out-of-area
      • Business transparency
      • Coronavirus (COVID-19)
      • Wellness
      • Wellness home
      • Preventive care
      • Care management
      • Advance care planning
      • Pregnancy & baby
      • Living Healthy home
      • Population health
      • Pharmacy information
      • Pharmacy benefits
      • Drug formulary
      • Flu vaccinations
      • Medication disposal
      • Find a pharmacy
  • Providers
      • Overview

      • Patient care
      • Coronavirus (COVID-19) providers
      • Provider tools
      • Clinical guidelines
      • SSM employee health plan
      • Resources
      • Automated authorization
      • Cultural Awareness & Health Equity
      • HIPAA transactions
      • Provider communications
      • Provider News
      • Medical management
      • Medical management home
      • Behavioral health
      • Genetic testing
      • Physical medicine
      • Radiology
      • Musculoskeletal program
      • Pharmacy information
      • Drug formulary-Illinois
      • Drug formulary-Missouri
      • Pharmacy services
      • Document library
  • Agents
      • Overview

      • Resources
      • Agent home
      • Agent Medicare certification
      • Advertising materials for agents
      • Agent supply request form
      • WellFirst Health
      • About us
      • News
      • Contact us
      • Sales contact
      • Media contact
      • Licensing
      • Licensing home
      • Agent application form
      • New agency (brokerage) application
      • Sole proprieter application
      • Shop plans
      • Individual & family plans
      • Find a doctor
      • Find a location
      • Find a pharmacy
  • Home
  • Providers
  • Medical Management

WellFirst Health Medical Management

group of providers talking

Authorization and coverage

Prior Authorization Services

Medical prior authorization service list

Injectables

Medical injectables list

Medical benefit prior authorization form

Medical oncology drugs (effective 1/1/2023)
 
Exception to coverage forms
For new FDA approved drugs on the market for less than a year that have not been reviewed or granted approval through the Pharmacy & Therapeutics Committee.
Pharmacy drug-IL
Pharmacy drug-MO
Medical injectable drug-IL
Medical injectable drug-MO
Medicare injectable drug step B therapy
Medicare pharmacy drug step B therapy

Non-covered

Non-covered services
Non-covered durable medical equipment & supplies

Information & forms

doctor and a patient holding a clip board

WellFirst Health policies

  • Medical policies
  • Drug policies
  • Medical oncology drugs (effective 1/1/2023)
  • Clinical guidelines
  • Medicare Advantage medical management
Doctor at desk reviewing x-ray on computer

Prior authorization

  • Radiology/NIA
  • Musculoskeletal (MSK)
  • Pharmacy
  • Physical medicine
  • Genetic testing
  • Behavioral health
  • Automated authorization
Doctor and patient filling out form

Prior authorization forms

Illinois
  • Behavioral health
  • Dental
  • Durable medical equipment
  • Genetic testing
  • Home health/hospice
  • Outpatient
  • Skilled nursing facility/swing bed

Missouri
  • Behavioral health
  • Dental
  • Durable medical equipment
  • Genetic testing
  • Home health/hospice
  • Outpatient
  • Skilled nursing facility/swing bed
footer logo

Leave us a Google Review

Account login

Contact us

Pay your premium

Find a doctor

Find a location

About WellFirst Health

Careers

Individuals & families

Providers

Special Enrollment

Agents

News

Events

Document library

24-hour nurse advice line

Patient access

Traveling out-of-area

Wellness

Coronavirus (COVID-19)

Drug formulary

Legal

No surprises

Transparency in coverage

Privacy policy

Follow Us

Choose font size

A
A
A
©2023 SSM Health Insurance Co./SSM Health Plan/WellFirst Health. Members of SSM Health. All rights reserved.
  • Language Assistance Services:
  • العربية
  • 繁體中文
  • Deutsch
  • Español
  • Français
  • ગુજરાતી
  • 한국어
  • हिंदी
  • Hmoob
  • Italiano
  • Polski
  • Русский
  • Af-Soomaali
  • Tagalog
  • Tiếng Việt
  • اردو