Dear Provider,

As part of ongoing efforts to educate our provider network on authorization requirements, WellCare of Georgia would like to remind you that NO AUTHORIZATION is required for durable medical equipment (DME) purchases if provided by a participating network DME provider and billed charges are less than $200. Most nebulizers cost less than $200 and therefore would not require authorization as long as they are provided by a participating provider.

The physician’s office should send the prescription directly to a participating DME provider, who can generally deliver the equipment on the same day with proper notification. 

If the prescription is sent to a pharmacy that is not a participating DME provider, the claim will reject online at the pharmacy. The non-participating pharmacy should not submit an authorization for the service, as nebulizers are a DME benefit and not part of the pharmacy benefit. Rather, the member should be directed to a participating DME provider. Please note that the prescription for the albuterol nebulizer solution may be filled at a participating retail pharmacy.

We hope you find this information helpful in delivering service to our members in need of DME purchases such as nebulizers.  If you need assistance in locating a participating DME provider, please visit our website, georgia.wellcare.com, and use the Help Me Find a Provider function or contact your local Provider Relations representative.

Thank you for being a valued provider and for working with us to provide coordinated care services to our members.

Sincerely,