Behavioral health insourcing

We currently partner with Carelon to administer our behavioral health benefits. Because integrated, whole-person care is critical to successful healthcare, as of January 1, 2026, we will begin administering our behavioral health benefits internally. By bringing all capabilities for administering behavioral health services in-house, WellSense will be able to strengthen our support of holistic member care and fulfill our mission of delivering health equity to our members. 

By joining the WellSense network, behavioral health providers will have a more streamlined experience through a direct relationship with the health plan. As a WellSense provider, you will benefit from advantages such as integrated, whole-person care coordination; direct support for administrative inquiries; continuing education tools; and other features that will promote your ability to continue delivering high-quality care.

The WellSense advantage

  • Health equity
    Join a health insurance plan that goes beyond traditional healthcare by removing barriers to care, providing critical resources to help each member live their healthiest life.
  • Increased volume 
    We anticipate significant growth in Massachusetts and New Hampshire in our existing Medicaid, Medicare and Commercial plans and from our upcoming entrance to the NH ACA Marketplace.
  • Minimize time to reimbursement
    You can reduce your administrative burden by contracting as a behavioral provider directly with WellSense. We offer a very competitive fee schedule, online claims submission, online prior authorization and pay over 95% of properly submitted claims within 30 days of receipt.
  • Enhanced member choice and care
    Our extensive provider network offers increased access, directly supporting the members in your community. Members with more complex health issues receive additional support through our collaborative Behavioral Health and Medical Care Management programs. Licensed behavioral health clinicians and registered nurses are on staff to help coordinate member care with a focus on the integration of behavioral and medical healthcare.

Frequently asked questions

All WellSense products will have behavioral health services administered by WellSense as of January 1, 2026. Our products currently include Massachusetts Medicaid, Massachusetts Medicare, Massachusetts ACA, New Hampshire Medicaid, New Hampshire Medicare, and New Hampshire ACA. To continue to see WellSense members after this date, you must contract directly with WellSense.

To continue to see WellSense members on or after January 1, 2026, you will need a provider agreement directly with WellSense. If you have additional questions regarding your relationship with Carelon please contact Carelon directly via their National Provider Services Line at 800-397-1630, Monday to Friday, 8 a.m. to 8 p.m. ET.

Andros is a vendor that WellSense has contracted with to assist in the building of the behavioral health network. They will be assisting with the contracting process to ensure we have a comprehensive behavioral health network by January 1, 2026.

While most providers can expect to be contacted by Andros, our own WellSense network strategy teams will be reaching out to larger hospital systems, community mental health centers and community behavioral health centers as applicable in Massachusetts and New Hampshire. 

During the credentialing process, WellSense or Verisys will collect and verify the information contained within your CAQH profile. If additional information or documentation is required, you or your credentialing representative will be contacted. Typically, this process is completed within 30 days of receiving a clean and complete application.

WellSense partners with Verisys, an NCQA-accredited credentialing verification organization that is responsible for collecting and verifying providers’ credentialing information. Verisys may contact providers directly to obtain additional information or documentation. Maintaining communication with Verisys helps ensure timely and accurate completion of the credentialing process.

We advise submitting your signed contract and completed credentialing and provider enrollment forms as soon as possible to ensure inclusion for January 1, 2026. Providers who are contracted and fully credentialed in advance of January 1, 2026, will be listed in the directory for January 1, 2026.

Yes, the WellSense Provider Portal is an online platform designed for healthcare providers to access essential information to streamline administrative tasks. Through the WellSense portal, providers can check member eligibility, review the status of claims and payments and download necessary reports. Additional detailed information will be made available in 2025.

Carelon remains the behavioral health vendor for WellSense through December 31, 2025. Claims for covered behavioral health outpatient services rendered on or before December 31, 2025, should be submitted to Carelon. Claims for behavioral health outpatient services rendered on or after January 1, 2026, should be submitted to WellSense. Carelon will continue to manage inpatient facility claims for covered services that begin prior to January 1, 2026, through discharge, even if the member is there after January 1, 2026. WellSense and Carelon will continue to work together to ensure payments are rendered timely and accurately through this transition.

Yes, you must grant WellSense access to your CAQH data to be successfully credentialed and continue to be a WellSense behavioral health provider. Additionally, please ensure that your profile is current and regularly attested to in order to prevent delays in the credentialing process.

Please refer to our online provider directory for a full list of participating facilities. Our behavioral health provider network will be open to expansion for our January 1, 2026, insourcing of behavioral health services.