Provider resources overview
We are committed to supporting you in providing quality care and services to Wellpoint members. In this section, you will find frequently used forms, provider manuals and guides, prior authorization information, clinical practice policies, and other support for delivering benefits to our members.
Forms
Provider forms are located in our online library for easy access.
Training academy
Wellpoint offers training and tutorials to support providers in continuing their education. Presentations, videos and other training documentation will be added as they become available.
Provider manuals and guides
Wellpoint provider manuals and guides provide key administrative information, including information about member eligibility, covered services, the utilization management program, credentialing standards for participation, claims submission and appeals, rights and responsibilities, reimbursement and administration policies, and the quality management program. On the provider manuals and guides page, you can also find information about medical policies and clinical utilization management guidelines.
Learn about Availity
Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into your account on the Availity Essentials .
Prior authorizations
Wellpoint makes determinations about selected inpatient or outpatient medical services including surgeries, major diagnostic procedures and out-of-network referrals to validate medical necessity.
Behavioral health
The Wellpoint behavioral health provider network includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance healthcare professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs, and intensive outpatient services and programs.
Additional information
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Referrals
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
Interested in becoming a provider in the Wellpoint network?
We look forward to working with you to provide quality services to our members.
Join our network