If you are not a Well Sense Health Plan network provider and will be administering a one-time service to a member, you must complete this Non-Participating Provider Activation Form to receive payment.
Fax the completed form along with your W-9 form to 617-897-0845, to the attention of the Provider Enrollment Department.
You must receive prior authorization before delivering services to a Well Sense Health Plan member. Use the Universal Prior Authorization Form or call 877-957-1300 Option 3.
Please note: If you do not obtain prior authorization, your claim may be denied, unless the claim is for emergency care.