Non-Participating Providers

Notice: Federal No Surprises Act Qualified Services/Items

If you are not a WellSense network provider and will be administering a one-time service to a WellSense member, you must do the following to receive payment:

Complete the Non-Participating Provider Activation Form
Fax the completed form, along with a copy of your W-9 form, to 617-897-0818, to the attention of the Provider Enrollment Department

Prior Authorization

You must receive prior authorization before delivering services to a WellSense member. Complete the Universal Massachusetts Prior Authorization Form, or call 800-900-1451, Option 3.

If you do not obtain prior authorization, your claim may be denied, unless the claim is for emergency care.

Senior Care Options

If you're delivering a service to a WellSense Senior Care Options member, you must also submit a Waiver of Liability.

Documents & Forms

Access administrative forms and documents.

Prior Authorization

Senior Care Options

Documents & Forms