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Use this form as part of the wellcare of north carolina. Provider waiver of liability (wol). You can ask for an appeal yourself. Web provider request for reconsideration and claim dispute form. Provider waiver of liability (wol) ꭱꮃꮧꮯ ꭶꮲꮝꭼꭲ. Use this form as part of the wellcare by allwell request for. Use this form as part of the wellcare by allwell request for. Web provider request for reconsideration and claim dispute form. You may also ask a friend, a family member, your provider or a lawyer to help you. Web request for reconsideration and claim dispute form. Web to appeal an authorization in denied status, search for the authorization using one of these criteria: