Claims

Providers

Reimbursement Policies

The policies below summarize Well Sense Health Plan's claims payment guidelines for specific services. The reimbursement policies are used as a guide by the Plan to make determinations regarding health care reimbursement. The Plan's policies undergo regular updates; check back often for the most up-to-date information.

Providers are reminded that member eligibility is determined before clinical 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.

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NOTE: The policy titles below include the product name they are associated with.

WS - Well Sense Medicaid
WSMA - WellSense Medicare Advantage

Search Reimbursement Policies

Type	Title	Language
	Adult Medical Day Care (WS 4.10), Effective 4/1/21	Reimbursement Policies
	Ambulatory Surgery Center, WS 4.31; Effective 02/01/22	Reimbursement Policies
	Ambulatory Surgical Center - Facility, WSMA 4.31; Effective 2/1/2022	Reimbursement Policies
	Anesthesia, WS 4.11; Effective 3/1/2022	Reimbursement Policies
	Anesthesia, WSMA 4.11; Effective 3/1/2022	Reimbursement Policies
	Bilateral and Multiple Procedure Reductions – Professional, 2169, Effective 4/1/2022	Reimbursement Policies
	Bilateral and Multiple Procedure Reductions – Professional, WSMA 2201, Effective 4/1/2022	Reimbursement Policies
	Chiropractic Services, 2202, Effective 05/01/2022	Reimbursement Policies
	Clinical Trials, WS 4.12 Effective 7/1/2021	Reimbursement Policies
	Clinical Trials, WSMA 4.12, Effective 01/01/22	Reimbursement Policies
	CPT and HCPCS Level II Modifiers Reported on CMS-1500 Claims Reimbursement Policy (WS 4.23), Effective 05/15/21	Reimbursement Policies
	Critical Access Hospitals, WSMA 4.212, Effective 01/01/22	Reimbursement Policies
	Diabetes Self-Management Training Medical Nutrition Therapy (WS 4.32), Effective 11/1/21	Reimbursement Policies
	Dialysis Reimbursement Policy (WS 4.13), Effective 11/01/21	Reimbursement Policies
	Drug Screening/Testing (DS/T): Drugs of Abuse Policy ( WS 4.94), Effective 07/01/21	Reimbursement Policies

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