A member can revoke the authorization at any time.Īn "appeal" is the type of complaint you make when you want us to re-evaluate and change a decision we have made about what benefits are covered for you or what we will pay for a benefit. The Appointment of Representative Form is valid for one year from the date indicated on the form. The form will be valid during the entire appeal/grievance process. Wellcare By Allwell Medicare requires a copy of the completed and signed Appointment of Representative Form to process an appeal filed by the member’s representative. The surrogate will need to give Wellcare By Allwell Medicare copies of the legal papers supporting his or her status as the member’s authorized representative. Print and complete the Appointment of Representative form. (By clicking on this link you will be leaving the Wellcare By Allwell website.) If a member is incapacitated or legally incompetent a surrogate is not required to submit an Appointment of Representative Form.A member can revoke the authorization at any time. (By clicking on this link you will be leaving the Wellcare By Allwell website.) If a member is incapacitated or legally incompetent a surrogate is not required to submit an Appointment of Representative Form. Print and complete the Appointment of Representative form.The person acting on behalf of the member must sign, date and complete the same form.The member must sign, date, and complete a representative form.Prior Authorization, Step Therapy, & Quantity Limitations.Coverage Determinations and Redeterminations.
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