Authorized Representative

Appointing a Representative

You can ask a relative, friend, advocate, doctor or anyone else to represent you. You and your representative must sign a legal letter that allows them to act for you. Your representative can file a complaint (grievance), make appointments or make an appeal for you.

If your representative needs to request a prior authorization, download the CMS-1696 Appointment of Representative Form (PDF), complete it and mail it to:

Medical Appeals (Part C) for items, Services, and Part B Drugs, and Medical Grievances (Part C & D):

Mail:
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
Appeals and Grievances
Medicare Operations
7700 Forsyth Blvd
St Louis, MO 63105

Fax:1-844-273-2671

Prescription Drug Appeals (Part D):

Mail:
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
Medicare Part D Appeals
P.O. Box 31383
Tampa, FL 33631-3383

Fax: 1-866-388-1766

Appointing a Representative

You can ask a relative, friend, advocate, doctor or anyone else to represent you. You and your representative must sign a legal letter that allows them to act for you. Your representative can file a complaint (grievance), make appointments or make an appeal for you.

If your representative needs to request a prior authorization, download the CMS-1696 Appointment of Representative Form (PDF), complete it and mail it to:

Medical Appeals (Part C) for items, Services, and Part B Drugs, and Medical Grievances (Part C & D):

Mail:
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
Appeals and Grievances
Medicare Operations
7700 Forsyth Blvd
St Louis, MO 63105

Fax:1-844-273-2671

Prescription Drug Appeals (Part D):

Mail:
Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)
Medicare Part D Appeals
P.O. Box 31383
Tampa, FL 33631-3383

Fax: 1-866-388-1766