Naloxone Kit Reimbursement

To obtain reimbursement for Naloxone kits distributed to Well Sense member, please send the following information to Well Sense Health Plan:

  1. W-9 form
    1. Well Sense will reimburse you through its Accounts Payable system, not its claim system, and as such will need a completed W-9 form. The W-9 form is required only the first time a provider submits an invoice.
  2. A completed Vendor Authorization Agreement for ACH Payments.
    1. Well Sense will transmit payment via electronic means to your financial institution.Please be sure to include your financial institution details, either in the form of a voided check, or by filling out the appropriate section of the authorization form.
    2. Please note that the address on the ACH Authorization form will be linked to the bank account you provide.Additionally, please be sure that the address used on your invoice matches the address on your ACH Authorization form.
  3. A completed invoice with supporting documentation in the form of a receipt (or copy of receipt) for the cost of the kit(s) that you are billing to Well Sense.


Three ways to submit this information for reimbursement:


  1. Email:
  2. Fax: 617-897-0886
  3. Mail:

Attn: Accounts Payable   

Boston Medical Center Health Plan, Inc.         

529 Main Street, Suite 500         

Charlestown, MA 02129  

If you have any questions about this process, please contact Beacon provider relations at