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

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