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
Ambulatory Surgical Center – Facility, WSMA 4.31, Effective 01/01/22 Reimbursement Policies
Anesthesia (WS 4.11), Effective 04/01/21 Reimbursement Policies
Anesthesia, WSMA 4.11, Effective 01/01/22 Reimbursement Policies
Bilateral and Multiple Procedure Reductions – Professional, WSMA 4.24, Effective 01/01/22 Reimbursement Policies
Chiropractic Services, WSMA 4.35, Effective 01/01/22 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 01/01/21, Retired 10/31/21 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 06/01/21, Retired 10/31/21 Reimbursement Policies
Dialysis Reimbursement Policy (WS 4.13), Effective 11/01/21 Reimbursement Policies

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