Provider policies

The policies below summarize WellSense Health Plan's coverage criteria and claims payment guidelines for specific services.

Radiology, genetic testing and musculoskeletal services policies
Including joint surgeries, spine surgeries, and interventional pain management treatments

Providers are reminded that member eligibility is determined before medical coverage policies and reimbursement guidelines are applied to any claim. As a result, the Plan can not guarantee payment when a member is ineligible or a non-covered benefit is rendered. Please review our Provider Manual for more information.