How to Fill Out and Submit the WellMed Prior Authorization Form (ePRG)

To submit a WellMed prior authorization form, log in to the ePRG provider portal at eprg.wellmed.net, confirm the service appears on WellMed’s Prior Authorization List, enter the patient and provider identifiers along with the diagnosis and procedure codes, and upload the clinical documentation that supports medical necessity. WellMed is a network of clinicians within Optum Health that administers utilization management for the Medicare Advantage plans it supports, which is why you file through its own portal rather than a generic UnitedHealthcare workflow. Submit at least 14 days before the planned date of service so the review team has room to decide without pushing the patient’s care back.

Signing In or Registering for ePRG

The portal lives at eprg.wellmed.net. If your practice already has an account, sign in with your One Healthcare ID, the single sign-on credential used across Optum and UnitedHealth Group provider tools. If you do not have one, the login screen has a registration link.

For a brand-new practice, select “Register” and enter the Tax Identification Number tied to your practice. The system validates the TIN before letting you proceed. Once it clears, you create your One Healthcare ID and link it to the practice. After registration, the portal opens up authorization and referral submissions, claims status, and patient management tools. Keep your TIN and NPI within reach during setup, because the account is tied to both.

Check the Prior Authorization List First

Not every service needs prior authorization. WellMed publishes a Prior Authorization List (PAL) that spells out which procedures, services, and equipment codes require approval before you deliver them. The current version, effective July 1, 2026, is posted as a PDF on the WellMed website and lists services by category with the applicable CPT or HCPCS codes.¹ WellMed updates the list periodically, so check for revisions before assuming a previously exempt service still skips the queue.

Common categories that land on the list include advanced imaging (MRI, CT, PET), elective surgeries, certain specialty drugs administered in a clinical setting, home health services, and durable medical equipment. If a code is not on the PAL, you generally do not need prior authorization, but confirm against the patient’s specific plan documents when in doubt, because benefit designs vary across the Medicare Advantage products WellMed supports.

Gather Your Documentation Before Starting

A request that reaches a reviewer missing key pieces comes back as a request for additional information, which burns days off the decision clock. Pull everything together before you open the submission form.

Administrative Identifiers

Patient’s full legal name and WellMed member ID number from the insurance card.
Your 10-digit National Provider Identifier (NPI) and the practice’s TIN.
ICD-10-CM diagnosis codes for the patient’s condition paired with the CPT or HCPCS codes for the specific procedure or equipment.¹
The name and address of the servicing facility along with the proposed date or date range.

Clinical Evidence

This is where requests succeed or fail. The reviewer needs enough to see that the service is medically necessary for this patient, not just that the diagnosis exists but that less intensive options were tried or ruled out. At a minimum, prepare:

Recent office visit notes with the history of present illness, exam findings, and the assessment and plan.
Diagnostic results: labs, imaging reports, pathology, or other tests supporting the clinical rationale.
Prior treatment history documenting conservative therapies already attempted, such as physical therapy records, medication trials, or injection logs. Surgical requests lean heavily on this.
Specialist consultation notes if a surgeon or specialist is involved.

Match the scope of documentation to the complexity of the request. A routine advanced imaging study may need only the office note and a brief clinical rationale. A spinal fusion request will need months of conservative treatment records, imaging, and a detailed surgical plan. When in doubt, over-document. A reviewer who has everything on the first pass can approve faster than one who has to kick the request back.

DME requests carry extra layers. Include the prescribing provider’s detailed written order, the face-to-face encounter note, and any test results that establish medical necessity for the item.

Submitting the Request

WellMed accepts prior authorization requests through two channels: the ePRG portal and, as a backup, by phone.

Through the Portal

Sign in at eprg.wellmed.net and go to the authorization submission section. Enter the patient’s member ID, your NPI and TIN, the diagnosis and procedure codes, the servicing facility, and the proposed service dates. The portal then prompts you to upload supporting documents in PDF or JPEG. Label each file clearly, something like “OfficeNote_2026-06-15” or “MRI_LumbarSpine,” so the reviewer can match documentation to the request without guessing.

Before hitting submit, review every field on the verification screen. A transposed digit in a member ID or a mismatched procedure code will stall the review. Once you submit, the portal generates a confirmation number on screen. Save or print it immediately. That number is your tracking key for every follow-up.

By Phone

Providers who cannot use the portal can submit prior authorization requests by phone at 877-757-4440. The line is call-only; no fax option is listed. Have all identifiers and clinical documentation organized before dialing, because the representative will walk through the same data points the portal collects. Phone submissions take longer and leave more room for transcription errors, so the portal is faster and more reliable when it is available.

When to Expect a Decision

Federal regulation sets the outer limits, and a key change took effect January 1, 2026. For any service subject to WellMed’s prior authorization requirement, the plan must issue a decision within 7 calendar days of receiving the request, down from the previous 14 calendar days.²

WellMed can extend that window by up to 14 additional calendar days if you or the patient request the extension, if the plan needs medical evidence from an outside provider that could change a denial, or if other extraordinary circumstances justify the delay. If WellMed extends, it must notify the patient in writing with the reason and inform them of the right to file an expedited grievance.²

Part B drug requests move faster: 72 hours, with no extension allowed.² Expedited requests, reserved for situations where waiting could seriously jeopardize the patient’s life, health, or ability to regain maximum function, also carry a 72-hour decision window.¹ Use the expedited pathway only when the clinical situation truly warrants it. Flagging routine requests as urgent slows the queue for patients who actually need fast answers.

Tracking Status and Answering Requests for More Information

After submission, the ePRG status tool shows the current stage: received, under review, pending additional information, or finalized. Check it regularly instead of waiting for an outbound notification. If the status flips to “additional information requested,” upload the missing document the same day if you can. Every day of delay eats into the decision timeline.

When the review wraps, WellMed sends the final determination through the portal and may also transmit it by electronic fax. An approval notice includes the authorized service, the approved date range, and any conditions such as a specific facility or a set number of visits. Keep the authorization number with the claim. Submitting a claim without the matching auth number is one of the most common reasons payment gets denied on services that were actually approved.

If the Request Is Denied

A denial notice must include the specific clinical reason the request was turned down. Read it closely. Sometimes the issue is not that the service is clinically inappropriate but that the documentation was insufficient to show necessity. In those cases, resubmitting with stronger records (an updated office note, a more detailed surgical rationale, additional imaging) can resolve it without a formal appeal.

If you believe the denial is wrong on the merits, the patient, or you acting as their representative, can request a reconsideration from WellMed. The reconsideration must be filed within 60 calendar days from the date of the denial notice. Standard reconsiderations must be in writing unless the plan accepts verbal requests; expedited reconsiderations can be verbal or written.³ If the plan upholds the denial, the case moves to an independent review entity, and the process can continue through up to five levels of appeal.⁴

Gold Card Exemption for High-Approval Practices

Practices with consistently high approval rates may qualify for UnitedHealthcare’s National Gold Card program, which removes the prior authorization requirement for designated codes. Because WellMed operates within the UnitedHealth Group network, providers treating WellMed patients through UnitedHealthcare-administered plans may benefit.

To qualify, your practice’s TIN must meet all three criteria:

Be in-network for at least one UnitedHealthcare health plan, including Medicare Advantage.
Submit at least 10 eligible prior authorizations per year for two consecutive years across Gold Card-eligible codes.
Maintain a prior authorization approval rate of 92 percent or higher across all Gold Card-eligible codes for each review year.⁵

Once your TIN qualifies, the exemption covers all providers associated with it. You skip the prior authorization step for Gold Card-designated codes but still submit an advance notification so the plan knows the service is coming. If your TIN met the criteria but was not selected, you can request a one-time review through the UnitedHealthcare provider portal.⁵

1
WellMed. WellMed Prior Authorization Requirements Effective July 2026
2
eCFR. 42 CFR 422.568 – Standard Timeframes for Organization Determinations
3
Centers for Medicare & Medicaid Services. Reconsideration by the Medicare Advantage (Part C) Health Plan
4
Medicare. Filing an Appeal
5
UnitedHealthcare. UnitedHealthcare National Gold Card Program