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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Search Reimbursement Policies

Type Title Language
Adult Medical Day Care (WS 4.10), Effective 4/1/21 Reimbursement Policies
Ambulatory Surgery Center Policy (WS 4.31), Effective 04/01/21 Reimbursement Policies
Anesthesia (WS 4.11), Effective 04/01/21 Reimbursement Policies
Clinical Trials, WS 4.12 Effective 7/1/2021 Reimbursement Policies
CPT and HCPCS Level II Modifiers Reported on CMS-1500 Claims Reimbursement Policy (WS 4.23), Effective 05/15/21 Reimbursement Policies
Diabetes Self-Management Training Medical Nutrition Therapy (WS 4.32), Effective 01/01/21 Reimbursement Policies
Dialysis Reimbursement Policy (WS 4.13), Effective 06/01/21 Reimbursement Policies
Drug Screening/Testing (DS/T): Drugs of Abuse Policy ( WS 4.94), Effective 07/01/21 Reimbursement Policies
Drug Waste (Policy 4.35), Effective 07/01/21 Reimbursement Policies
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy (WS 4.15), Effective 05/15/21 Reimbursement Policies
Emergent Transportation (WS 4.14), Effective 07/01/21 Reimbursement Policies
Family Planning, Sterilization, and Abortion (WS 4.16), Effective 01/01/21 Reimbursement Policies
General Billing and Coding Guidelines (WS 4.17), Effective 05/01/2021 Reimbursement Policies
General Clinical Editing and Payment Accuracy Review Guidelines (WS 4.18), Effective 05/15/21 Reimbursement Policies
Hearing Aid Services (WS 4.111), Effective 05/15/21 Reimbursement Policies

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